INTRACAVERNOSAL DRUG-INDUCED ERECTION THERAPY VERSUS EXTERNAL VACUUM DEVICES IN THE TREATMENT OF ERECTILE DYSFUNCTION

Objectives To determine if there is a significant difference between i ntracavernosal self-injection and external vacuum devices when compare d directly for satisfaction, effectiveness and side-effects. Patients and methods Fifty men were randomized into two groups and received eit her instruction on the use of the Osbon ErecAid(R) system or self-inje ction therapy. After 15 uses, each group completed a questionnaire det ailing efficacy, satisfaction and side-effects, and then changed to th e other modality after appropriate instruction. A questionnaire was co mpleted by study participants and their sexual partners after using bo th methods. Patients were followed for 18-24 months using telephone in terviews. Results Forty-four patients (mean age 62.3 years, range 38-8 4) completed the study, Patients and their partners reported a superio r quality of erections with the injection method but the difference di d not reach statistical significance. The ability to attain orgasm and the overall satisfaction of the patient and partner with the sexual e xperience was significantly better when using injections. Side-effects were similar between the modalities, Subgroups analysed for age, dura tion and aetiology of impotence showed that younger patients (<60 year s, those with a shorter duration of impotence (<12 months) and those i mpotent secondary to radical prostatectomy strongly favoured injection therapy (P<0.05). Overall, of the 44 couples, the final preferences o f the patients were 25 (57%), 12 (27%), six (14%) and one (2%) for the injection, vacuum device, bath or neither, respectively, and of the p artners were 22 (50%), 12 (27%), six (14%) and four (9%), respectively . At 18-24 months, 80% of patients were still using either the vacuum device, injections, or both. Conclusion Both the vacuum device and inj ections are effective treatment modalities for impotence and are assoc iated with good long-term success. Overall, there was a trend favourin g injection therapy over the vacuum device which was most significant in younger patients, those with a shorter duration of impotence, and t hose impotent secondary to radical prostatectomy.