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External vacuum devices

For patients with erectile dysfunction who cannot tolerate or do not respond to intracavernosal injections, there is a choice between a penile prosthesis or a vacuum device. A vacuum device works by creating penile congestion and enough rigidity to allow penetration (figure l). There are no comparative controlled studies and most of the questionnaire reviews are carried out by the manufacturers themselves. However, a satisfaction rate of 70% was reported by Price in diabetics, who also emphasized the importance of a stable relationship for success. One major disadvantage to the patient is that these devices are not available on the National Health Service and cost £200 or more. Of the 60% who were able to get an adequate erection, only one third purchased a device, claiming price as the limiting factor. There are few side-effects; some complained of pain and bruising at the site of the constricting rubber ring at the base of the penis and in a minority the partner found it an unacceptable method.

Although not universally popular, for some patients who cannot tolerate intracavernosal injections or are too elderly or unfit to be offered a penile prosthesis, a vacuum device may be a very effective treatment and it does not carry the risk of priapism.