How do success rates of penis pumps versus Viagra vary for men with diabetes, post-prostatectomy, or vascular disease?

1. Why the underlying cause matters: blood flow vs. nerve function

Erectile function needs both arterial inflow and intact nerve‑muscle responses; diabetes and vascular disease damage small arteries and smooth muscle while prostatectomy can injure cavernous nerves — and those differences change which therapy is likely to work. Boston University Medical Center explains that PDE5 inhibitors “tend to be less effective in the diabetic than in the non‑diabetic ED patient” because diabetes brings arterial and nerve damage ^[1]. Right as Rain and other clinical overviews emphasize that vascular disease is the dominant cause for many men with ED and can limit success of either pills or pumps unless targeted ^{[6] [7]}.

2. Viagra (PDE5 inhibitors): typical success and limits in diabetes and vascular disease

Viagra and other PDE5 inhibitors are effective for a large share of men overall, but multiple sources say they fail in a substantial fraction of men with type 2 diabetes — sometimes cited as “about half” or markedly reduced compared to men without diabetes ^{[2] [1]}. Clinical advice from endocrine/urology venues recommends starting with pills for diabetic patients but notes limited efficacy and the need to offer alternatives such as injections or VEDs when pills fail ^{[2] [1]}.

3. Penis pumps (VEDs): how well they work and for whom

Vacuum erection devices produce an erection mechanically by drawing blood into the penis and then using a constriction band; multiple clinical reviews and patient‑education sites describe VEDs as a reliable, low‑risk option that can “work” for many men who do not respond to medication, including after prostatectomy and in men with contraindications to PDE5 inhibitors ^{[8] [9] [10]}. Some consumer and clinic summaries report VED success rates cited up to high percentages in selected settings, and that VEDs can achieve erections within minutes ^{[11] [12]}. However, reported satisfaction varies and many men prefer oral medication when it works ^{[13] [14]}.

4. Post‑prostatectomy: rehabilitation and combination therapy

For men after radical prostatectomy, the literature emphasizes penile rehabilitation. Reviews and meta‑analyses note that VEDs are the second most commonly used rehabilitation method and that combining a PDE5 inhibitor with a vacuum device appears more effective for restoring erectile function and preserving penile length than single therapies in several studies ^{[3] [5] [15]}. WebMD and clinical programs stress early and combined approaches but also note mixed results across trials and the need for individualized plans ^{[16] [15]}.

5. Comparative success rates: what the sources actually quantify

Available sources do not give a single head‑to‑head success‑rate table across the three conditions requested. Some summaries claim VEDs can achieve erections in a high proportion of users (some pages cite figures up to ~90% in selected cohorts) and that PDE5 inhibitors work in roughly 70–85% of men overall though less in people with comorbidities — but those figures come from mixed sources and marketing/summary articles rather than uniform randomized comparisons ^{[11] [12] [8]}. Peer‑reviewed trials and meta‑analyses cited for specific settings (e.g., sildenafil + VED after prostatectomy) report improved intercourse‑capable penetration rates with combination therapy versus sildenafil alone in selected trials of diabetic men and post‑prostatectomy patients ^{[4] [5]}.

6. Patient experience, preferences and practical tradeoffs

Clinics and patient forums report many men prefer oral medications when effective because they are simpler and feel more “natural,” while VEDs are mechanical and can be cumbersome or cause bruising or numbness though with generally fewer systemic side effects ^{[14] [13] [16]}. Cost, ease of use, tolerance of the constriction band, and the need for a partner to accept the device are practical factors affecting uptake ^{[17] [14]}.

7. Takeaway for patients and clinicians

For men with diabetes or vascular disease who fail PDE5 inhibitors and for many post‑prostatectomy patients, vacuum devices are an evidence‑supported alternative or adjunct; combining VED and PDE5 inhibitors often improves outcomes in trials and reviews cited ^{[4] [5] [3]}. Specific success rates vary by study population, severity of nerve or arterial damage, and adherence, and available sources do not provide a single unified success‑rate comparison across all three conditions (not found in current reporting). Patients should discuss individualized rehab plans with a urologist who can cite condition‑specific evidence and safety considerations ^{[9] [8]}.

Limitations: the available items include clinical reviews, trials in particular populations, patient‑education and commercial summaries; they do not provide a single, comprehensive RCT dataset directly comparing pump vs Viagra success rates across diabetes, post‑prostatectomy and generic vascular disease in identical study designs (not found in current reporting).