Erectile dysfunction can be treated in a number of ways, including the use of penile traction therapy, vacuum erection devices, and vascular surgery. Last month, the Journal of Sexual Medicine published a review of the latest developments in these particular approaches and offered recommendations for each.
The review stemmed from a consensus panel held during the 2015 International Consultation on Sexual Medicine in Madrid, Spain. Panel members reviewed related medical literature and assessed its quality. They then discussed the material and developed the guidelines as published.
Highlights of the review include the following:
• Penile traction therapy (PTT). This therapy uses mechanical forces to lengthen or straighten the penis. Patients may benefit from PTT before penile implant surgery or after surgery for Peyronie’s disease. The approach may also be used alone or in conjunction with intralesional therapy during the acute phase of Peyronie’s disease.
• Vacuum erection devices (VEDs). VEDs generally include a cylinder, pump, and constriction ring. Together, these components create a vacuum that results in an erection. The method is usually effective for creating an erection suitable for intercourse and may help men with Peyronie’s disease.
Patients may also use a VED to preserve penile length after having a prostatectomy. However, VEDs may not be helpful in restoring natural erectile function after prostatectomy.
• Vascular surgery. The authors discussed several types of vascular surgery, including microarterial bypass surgery, endovascular therapy, venous ligation surgery, and venous embolization. The authors noted that no one procedure appeared to be better than another. Men under age 55 are probably more likely to have good outcomes, but men with diabetes or other vascular risk factors are not.
The authors did not recommend venous surgery or embolization to treat veno-occlusive dysfunction (VOD), but suggested that these approaches be further studied in clinical trials.
While the guidelines offer best practices on these treatment approaches, they are not intended to be “the definitive statement as to the only standard of care,” the authors wrote.
“Individual judgment and patient-specific factors will necessitate a deviation from guidelines on occasion and should be considered well within the intended scope,” they added.
The Journal of Sexual Medicine
Trost, Landon W., MD, et al.
“External Mechanical Devices and Vascular Surgery for Erectile Dysfunction”
(Full-text. November 2016)