Outcome analysis of patients with Peyronie’s disease who elect for vacuum erection device therapy

Introduction: Peyronie’s disease (PD) affects approximately 0.7–11% of men1 and has numerous proposed treatments. Invasive management options include surgical or injectable therapy, while penile traction therapy with vacuum erection device (VED) represents a noninvasive approach. Our objective is to assess outcomes for patients with PD who opt for noninvasive management. Methods: We performed a retrospective analysis for patients with PD who were followed for at least three months and opted for non-invasive therapy. All patients were instructed to initiate VED traction therapy for 10 minutes twice per day. Patients were assessed for degree of PD deformity and erectile function (Sexual Health Inventory for Men [SHIM] score) at initial and subsequent encounters. Results: Fifty-three patients met the inclusion criteria. The mean (standard deviation [SD]) age was 57 (12) years, and the mean (SD) duration of PD prior to assessment was 25 (15) months. The mean (SD) duration of followup was 14 (11) months. Among untreated patients who did not use a VED, nine showed improvement, 20 remained stable, and four had worsening curvature. The untreated group had a significant change in curvature, with a mean improvement (SD) of 3.6 (12)º (p=0.048). All 20 men who initiated VED traction therapy had an improvement in curvature with a significant mean (SD) improvement of 23 (16)º (p=2.6x10-6). Changes in SHIM scores did vary significantly between groups. No complications were noted. Conclusions: In patients who opt for non-invasive management of PD, VED traction therapy provides improved curvature resolution compared to those who do not use such a device. The limitations of this study include the retrospective nature and a small sample size at a single treatment center.

Medical Management of Erectile Dysfunction

The management of erectile dysfunction has made tremendous strides over the past four decades, owing to concomitant advances in our understanding of the complex neurovascular, hormonal, and psychologic processes involved in penile erectile. The field has transitioned from predominantly psychotherapy-based management to focused treatment modalities that have been rigorously tested for both safety and efficacy in the clinical setting. The etiology of the erectile dysfunction must first be ascertained through careful history-taking, physical examination, laboratory testing, and in select cases, imaging. Once the etiology is known, the urologist has numerous options in their armamentarium to improve symptomatology and quality of life. The use of psychotherapy, pharmacologic therapy, injectable therapy, intraurethral suppositories, topical agents, and vacuum-assist erection devices can be used as monotherapy or in combination to tailor treatment to patient needs. Future directions in erectile dysfunction management are focusing on therapies that alter the course of the disease and permanently restore erectile function, rather than simply treating the symptomatology. The continued advancements taking place in the preclinical setting demonstrate considerable promise for the treatment and ultimate cure for this disease. This review contains 6 figures, 1 table, and 50 references. Key Words: alprostadil, emerging therapies, erectile dysfunction, intracavernosal injection therapy, intraurethral suppository, medical management, papaverine, phentolamine, phosphodiesterase-5 inhibitors, vacuum erection device, vasoactive intestinal peptide