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The article focuses on engineering of cells and tissues for treatment of erectile dysfunction. Over the years, multiple treatment modalities have been proposed and attempted, both experimentally and clinically, for the treatment of erectile dysfunction. Although the overall outcome of vascular reconstruction for erectile dysfunction has been gradually improving due to the evolution of microsurgical techniques, operative complications, such as infection, vessel occlusions and overall operative morbidity, are not negligible. Intracorporal, intraurethral, topical and oral pharmacologic agents have been used widely in patients with erectile dysfunction.

The past decade has seen a better understanding of the physiology of erection and the pathophysiology of impotence as a result of considerable innovative research. These advances also introduce a new era in the diagnosis and treatment of impotence. Many functional tests and effective medical and surgical treatments are now available. With the sudden explosion of these many tests and therapies, clinicians are often confronted by questions such as: What constitues an adequate workup? What is the treatment of choice of arteriogenic impotence? Is nocturnal penile tumescence testing necessary? Is penile arteriography necessary? Over the past several years, the author has been using a patient's goal-directed approach to the diagnosis and treatment of impotence. This approach is based on (1) the most recent advances of diagnostic technique and therapy of impotence and (2) the patient's physical and mental health, motivation, and goal. This article briefly summarizes this practical patient's goal-directed management of impotence. [ABSTRACT FROM AUTHOR]

Vacuum devices, the least familiar treatment for impotence, have only recently attracted attention and been the subject of serious scientific inquiry. A vacuum draws blood into the penis under enough pressure to cause rigidity. The vacuum constriction device (VCD) uses a constricting ring or band about the base of the penis to keep blood trapped after the vacuum has been relieved. The vacuum entrapment (VE) device applies a continuous vacuum to the penis through a silicone sheath that is worn during intercourse. These devices cause penile rigidity in almost all men and appear to be quite safe. Published reports of long-term use of the VCD are few, but all indicate a high degree of patient and partner acceptance and satisfaction. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to compare the satisfaction rates obtained for vacuum constriction devices with those achieved using intracavernous pharmacologic injections in a group of patients afflicted with erectile dysfunction. The subjects were stratified into three groups: group 1 failed to achieve an adequate erection on pharmacologic injection, group 2 achieved satisfactory erection following pharmacologic injection, and group 3 was left untreated. All patients were given a vacuum constriction device. We assessed their satisfaction using a questionnaire. The data suggest high satisfaction rates in all three groups. Of particular interest was that over half of the patients who had successfully been treated with pharmacologic injections switched to the vacuum constriction device at the end of the study. The data indicate high levels of patient satisfaction with the vacuum constriction devices, even among subjects in whom prior alternative impotence therapy had been successful. [ABSTRACT FROM AUTHOR]