A 55-year old diabetic patient presented with impotence with history of failure to get erection after papavarine intracavernous injection. Color Doppler shows no abnormality of aeries but shows mild venous run-off. Treatment of choice:

Vaccum Erection Device Therapy In patients who donot respond to or decline oral or local vasoactive pharmacotherapeutic options, vaccum erection device therapy may be alternatively explored. The principle of vaccum erection device therapy is to mechanically create negative pressure surrounding the penis in order to engorge it with blood and then restrain egress from the organ to maintain the erection-like effect. Efficacy rates in acheiving satisfactory erections of 67-90%, but satisfactory rates with the device are lower, ranging from 34 to 68% The device is more acceptable to older men in a steady relationship comared to young, single men. Success is limited in patients with severe vascular abnormalities such as proximal venous leakage or aerial insufficiency or fibrosis secondary to priapism or prosthesis infection. Fuher, it may offer a means to preserve the elasticity of penile tissues after priapsim or penile prosthesis explanation or after surgical correction of peyronie&;s disease. It has been suggested to facilitate erection recovery after treatments for prostate cancer. Ref: Campbell 11th edition Pgno: 738