How do long-term success rates of vacuum erection devices compare to PDE5 inhibitors for erectile dysfunction?
Executive summary
Vacuum erection devices (VEDs) are a long‑standing, noninvasive option often used alone or as adjunctive therapy when phosphodiesterase‑5 inhibitors (PDE5‑Is) fail; systematic reviews and guideline statements note limited high‑quality long‑term efficacy data for VEDs in refractory ED, while PDE5‑Is remain first‑line with well‑documented short‑ and mid‑term success but up to ~40% of men report unsatisfactory response [1] [2] [3]. Multiple studies and reviews support combining VED and PDE5‑Is for salvage therapy, and VEDs are specifically recommended when PDE5‑Is are contraindicated [4] [2] [5].
1. Why this comparison matters: mechanics, access and patient selection
PDE5‑Is act systemically to enhance nitric oxide–cGMP signaling and are the recommended first‑line medical therapy; they have extensive randomized trial data and wide clinical acceptance [2] [6]. VEDs work mechanically by creating negative pressure to draw blood into the corpora cavernosa and are noninvasive and drug‑free, making them suited to men with cardiovascular contraindications or drug interactions that preclude PDE5‑Is [7] [2]. The two modalities therefore address ED through fundamentally different mechanisms and are used in different clinical niches [7] [2].
2. What the evidence says about long‑term success for PDE5 inhibitors
Major clinical guidance and reviews describe PDE5‑Is as first‑line with broad evidence of benefit; however, many men—estimates up to 40%—do not achieve satisfactory results with these drugs, creating a persistent need for alternatives or adjuncts [2] [3]. The sources provided emphasize robust short‑ and mid‑term trial evidence for PDE5‑Is but do not supply a single pooled long‑term (multi‑year) success rate in these materials; available sources do not mention a precise long‑term numeric success comparison beyond the ~40% nonresponder figure [2] [3].
3. What the evidence says about long‑term success for vacuum erection devices
Recent systematic reviews and meta‑analyses acknowledge that VEDs are widely used but highlight that high‑quality evidence for VED efficacy in refractory ED is limited; the 2025 Int J Impot Res meta‑analysis explicitly states available evidence for VED efficacy in refractory cases is limited [1] [8]. User evaluations and specialist reviews view VEDs as a first‑line or adjunctive option in specific contexts (post‑radiation, post‑prostatectomy), but again long‑term randomized data showing restoration of spontaneous erectile function are lacking or inconclusive in the cited sources [9] [2] [10].
4. Combination therapy: greater efficacy than monotherapy?
Multiple studies, including older randomized and prospective work and recent reviews, report that combining VED with PDE5‑Is can improve outcomes in PDE5‑I nonresponders and may be an effective salvage strategy before invasive options are offered [4] [5] [2]. The Cleveland Clinic materials and the 2015 and later combination studies conclude that combination therapy yields statistically significant improvements in validated erectile function measures compared with baseline and can be offered to men unsatisfied with PDE5‑Is alone [4] [2] [5].
5. Clinical contexts where the balance shifts toward VEDs
Guidance and user‑evaluation studies single out particular groups who benefit from earlier VED use: men who cannot take PDE5‑Is for cardiovascular reasons, post‑prostate cancer patients undergoing radiotherapy or androgen deprivation, and some post‑prostatectomy rehabilitation protocols where VEDs are used to reduce penile shortening [7] [9] [10]. In these settings, VEDs are often listed alongside PDE5‑Is as first‑line or adjunctive options [9] [10].
6. Limitations, gaps and competing viewpoints in current reporting
The literature included in these search results consistently notes a paucity of long‑term, high‑quality randomized trials directly comparing sustained, multi‑year success of VEDs versus PDE5‑Is; systematic reviews explicitly flag limited evidence for VED efficacy in refractory ED [1] [8]. Some specialty articles and device analyses portray VEDs as inexpensive, safe and useful adjuncts—an implicitly favorable stance toward broader VED use—whereas guideline‑focused reviews emphasize that VEDs do not yet have definitive evidence for restoring spontaneous erectile function [7] [2] [10]. These represent differing emphases rather than direct contradiction.
7. Practical takeaways for clinicians and patients
For most men, PDE5‑Is remain first‑line given the weight of trial data and tolerability; expect up to roughly 40% nonresponse and plan alternatives accordingly [2] [3]. For those who cannot take PDE5‑Is or who fail them, VEDs are an established, low‑risk option with documented symptomatic benefit and frequent use as part of combination salvage therapy, but long‑term comparative success rates versus PDE5‑Is are not well‑defined in current reporting [4] [5] [1]. Clinicians should present both evidence gaps and practical benefits, and discuss combination therapy before proceeding to more invasive measures [4] [2].
Limitations: This analysis relies only on the supplied sources; available sources do not provide a definitive long‑term numeric head‑to‑head success rate comparing VEDs to PDE5‑Is beyond the qualitative and subgroup findings cited above [1] [2].