STORIE COMUNI DI UN FERRAGOSTO IN CITTA’ Ci diamo appuntamento quasi con religioso senso del dovere, come si ritrovano all’immancabile raduno annuale gli orgogliosi proprietari delle auto vintage, le Bianchine, le Prinz, che in un batter d’occhio da oggetto di scherno sono diventate oggetto di culto. Nutro seri dubbi che fra 30 anni alla sciagurata Fiat Multipla toccherà la stessa sor
Jabfm.orgVacuum Erection Device Use in Elderly Men: APossible Severe Complication Robert L. Bratton, MD, and Harvey D. Cassidy, MD Erectile dysfunction affects up to 30 million Amer- erectile dysfunction. The patient had used a vac- ican men and their partners. Between the ages of 40 uum erection device for the last 5 years without and 70 years, the probability of complete erectile complications. We received a frantic call from his dysfunction triples from 5.1% to 15%.1 Erectile wife, who stated that her husband had attempted to dysfunction is deﬁned as the persistent inability to use the vacuum erection device but was now in attain or maintain penile erection sufﬁcient for sex- considerable pain, with his penis and testicle turn- ual intercourse. In 1992 the National Institutes of ing blue. She was advised to cut the constricting Health Consensus Development Conference rec- ring but was unable to do so and was told to bring ommended that the term “erectile dysfunction” replace “impotence” because it more accurately de- When he arrived, the patient reported that he ﬁned the problem with fewer negative implica- had used the vacuum erection device approximately 15 to 30 minutes before arrival for medical care.
Many therapeutic options, with varying degrees When he placed the constricting ring at the base of of patient satisfaction, are now available for erectile his penis, he unintentionally trapped his right tes- dysfunction. These options include pharmacologic ticle under the plastic ring. When he was examined, agents such as yohimbine, sildenaﬁl (Viagra), int- it was apparent that his wife had cut the ﬁnger grip racavernosal alprostadil (Caverject), and transure- in an effort to remove the device, but she had not thral alprostadil (MUSE). Nonpharmacologic cut the constricting ring itself. Swelling and ecchy- treatment includes vacuum erection devices, penile prostheses, and penile revascularization. Of these After excision of the plastic constriction band, choices, vacuum erection devices are most com- normal color and associated blood ﬂow were im- mediately restored to the testicle, but the area re- In most men, vacuum erection devices induce mained tender to palpation. The patient was in- penile rigidity sufﬁcient for vaginal penetration re- structed to rest, apply cool compresses, and elevate gardless of the reason for erectile dysfunction. Such the area to prevent any further edema. After dis- devices are considered safe and relatively easy to missal home, no further symptoms were reported.
use.2 Complications can occur, however. We de-scribe a patient whose case illustrates a potentiallydangerous complication of using a vacuum erection Discussion
Vacuum erection devices are usually tolerated andeffective, with low morbidity and few recognized Case Report
An 85-year-old man came to the Mayo Clinic Pri-
complications.3 A previous study showed that men mary Care Clinic for an emergency visit. The pa- who had moderate erectile dysfunction had a tient’s medical history was notable for hyperten- higher success rate in using vacuum erection de- sion, hypothyroidism (necessitating replacement vices than did patients with mild or severe erectile therapy), benign prostatic hypertrophy (transure- dysfunction.4 An additional study showed that thral resection of the prostate), and multifactorial 83.5% of 5,847 vacuum erection device users con-tinued to use the device for intercourse as desired.5The device is effective for many couples in thetreatment of erectile dysfunction associated with Submitted, revised, 10 April 2002.
From the Department of Family Medicine (RLB, HDC), spinal cord injury.6 Vacuum erection devices have Mayo Clinic, Jacksonville, Fla. Address reprint requests to also been found to be safe in patients receiving Robert L. Bratton, MD, Department of Family Medicine,Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224.
Instructions for the use of vacuum erection de- injury, anticoagulation, and others), primary care vices specify that the constricting band should be physicians should familiarize themselves with po- applied for no more than 30 minutes. Men with tential severe complications. Prompt or urgent unexplained priapism or bleeding disorders should treatment might be necessary to prevent serious not use the device.5 According to the manufactur- ers’ information and published literature, compli-cations include discomfort, local irritation, and ec- References
chymosis. Urethral bleeding, skin necrosis at the 1. Althof SE, Seftel AD. The evaluation and manage- ring site, development of a cystic mass, penile ec- ment of erectile dysfunction. Psychiatr Clin North chymosis, and development of Peyronie disease 2. American Urological Association issues treatment With the increasing aging population, physical guidelines for erectile dysfunction. Am Fam Physi- limitations, such as loss of dexterity, decreased vi- sual acuity, decreased hearing, and other associated 3. Ganem JP, Lucey DT, Janosko EO, Carson CC.
deﬁcits related to aging, can lead to incorrect use of Unusual complications of the vacuum erection de-vice. Urology 1998;51:627–31.
such devices. Thus, primary care physicians will be 4. Dutta TC, Eid JF. Vacuum constriction devices for confronted with unforeseen complications of ther- erectile dysfunction: a long-term, prospective study apeutic options that were previously considered of patients with mild, moderate, and severe dysfunc- safe but are in fact potentially dangerous to the 5. Lewis RW, Witherington R. External vacuum ther- apy for erectile dysfunction: use and results. World Conclusion
Effective treatment for the common problem of 6. Denil J, Ohl DA, Smythe C. Vacuum erection device in spinal cord injured men: patient and partner sat- erectile dysfunction can be achieved with various isfaction. Arch Phys Med Rehabil 1996;77:750 –3.
methods. In many cases patients respond well to 7. Limoge JP, Olins E, Henderson D, Donatucci CF.
and prefer the vacuum erection device. Although Minimally invasive therapies in the treatment of this device is associated with few side effects and erectile dysfunction in anticoagulated cases: a study can be beneﬁcial in many situations (spinal cord of satisfaction and safety. J Urol 1996;155:1276 –9.
502 JABFP September–October 2002 Vol. 15 No. 5
care sheet guppies (Poecilia reticulata) To successfully keep guppies under commercial conditions, one must follow the lead of commercial breeders. The wild guppy originated from South America, but nearly all guppies sold in Australia today are bred in Asia. Male guppies are raised in ponds, where they are kept in water with a relatively high total dissolved solids con