Combined sildenafil with vacuum erection device therapy in the management of diabetic men with erectile dysfunction after failure of first-line sildenafil monotherapy

Int J Urol. 2014 Dec;21(12):1263-7. doi: 10.1111/iju.12564. Epub 2014 Jul 14.


Objective: To evaluate the efficacy and safety of combination therapy of sildenafil plus vacuum erection devices in men with type 2 diabetes mellitus with moderate to severe erectile dysfunction who are dissatisfied with the results of using sildenafil alone.

Methods: The study included 66 diabetes mellitus patients presenting erectile dysfunction for at least 6 months and dissatisfied with the use of 100 mg sildenafil monotherapy. The patients were randomized in two groups. Those in group A (n = 33) were instructed to use a vacuum erection device only, whereas those in group B (n = 33) were treated with combination therapy, including sildenafil 100 mg and a vacuum erection device. Erectile function was evaluated subjectively using the International Index of Erectile Function, Sexual Encounter Profile questionnaire questions 2 and 3 at visit 1 (baseline; study entry), visit 2 (4 weeks after baseline), and visit 3 (12 weeks after baseline; study end).

Results: There were no significant differences in average patient age, duration of diabetes, duration of erectile dysfunction, baseline International Index of Erectile Function scores, hypertension, blood testosterone, smoking and alcohol consumption between two groups. Mean International Index of Erectile Function scores were significantly higher for group B at the 1-month (14.86 ± 2.17 vs 12.41 ± 2.63; P < 0.0001) and 3-months (17.53 ± 2.95 vs 14.29 ± 2.81; P < 0.0001) visits. Men in group B had better successful penetration (73.3% vs 46.6%) and successful intercourse (70% vs 46.6%) at 3 months compared with group A.

Conclusion: Combined use of sildenafil and vacuum erection device therapy significantly enhances erectile function, and it is well tolerated by diabetes mellitus patients not responding to first-line sildenafil alone.

Keywords: diabetes mellitus; erectile dysfunction; sildenafil; vacuum erectile device.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Diabetes Mellitus, Type 2 / complications*
  • Double-Blind Method
  • Erectile Dysfunction / complications
  • Erectile Dysfunction / physiopathology
  • Erectile Dysfunction / therapy*
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Penile Erection / physiology*
  • Piperazines / therapeutic use*
  • Purines / therapeutic use
  • Retrospective Studies
  • Sexual Behavior / physiology*
  • Sildenafil Citrate
  • Sulfonamides / therapeutic use*
  • Surveys and Questionnaires
  • Treatment Failure
  • Vacuum
  • Vasodilator Agents / therapeutic use


  • Piperazines
  • Purines
  • Sulfonamides
  • Vasodilator Agents
  • Sildenafil Citrate