I. Vacuum device on-demand treatmentThe vacuum device draws blood into the penile corpus cavernosum through negative pressure, and then a constriction ring is applied to the root of the penis to stop blood flow back to maintain erection. This method is indicated for patients who have failed to respond to PDE5 inhibitor therapy or who cannot tolerate medication, and is especially indicated for older patients who have occasional sex. Adverse effects include penile pain, numbness, and delayed ejaculation. Patients should be informed at the time of use that the duration of negative pressure erection aid should not exceed 30 minutes. Contraindications include spontaneous abnormal erections, intermittent abnormal erections and patients with severe penile deformities. The risk of petechiae, ecchymosis and hematomas is higher in patients with coagulation disorders or on anticoagulation therapy when using the vacuum device. Patients who have not been treated with PDE5 inhibitors or vacuum devices alone may be treated in combination. Second, vacuum device rehabilitation for erectile function after surgery or trauma ED is a common complication after radical prostatectomy (RP) for prostate cancer. Postoperative damage to the cavernous nerves and reduced arterial perfusion lead to cavernous tissue hypoxia, apoptosis and collagen deposition, and eventually to venous leakage. Vacuum erection device (VED) can prevent apoptosis and fibrosis of penile corpus cavernosum tissue by dilating cavernous arteries and improving hypoxia. Early postoperative application of the VED promotes recovery of erectile function and maintains penile length. the VED is usually started within 1 month after surgery, once daily for 10 minutes, or two consecutive negative pressure suction sessions of 5 minutes each, separated by brief suction releases, for 3-12 months. The combination of PDE5 inhibitor and VED was more effective in the rehabilitation of erectile function compared with PDE5 inhibitor alone after RP surgery. Among patients who still obtained natural insertion hardness 5 years after surgery, 60% of patients used VED as early rehabilitation therapy for penile erection. Section 6: Vascular surgery for penile erectile dysfunction Surgical treatment of penile venous leaks The hemodynamics of veno-occlusive dysfunction (venous leak) ED are largely clear, but it is more difficult to identify functional abnormalities (smooth muscle dysfunction) and anatomical defects (white membrane abnormalities). Currently, there is no clear standardized diagnostic procedure for veno-occlusive dysfunctional ED, the results of randomized controlled clinical studies are inadequate, and the effectiveness of the procedure has yet to be validated. Section 7: Prosthetic implant treatment I. Indications and contraindications Indications: 1. Patients for whom oral medications and other treatments are ineffective; 2. Patients who cannot accept or tolerate existing treatments. Absolute contraindications: 1, the presence of systemic, skin or urinary tract infection. Relative contraindications: 1. Patients with severe penile deformity, penile dysplasia, penile hemangioma. 2. Patients with psychosomatic disorders that have not been effectively treated. The main purpose of preoperative preparation for patients who are to undergo penile prosthesis implantation is to reduce the risk of infection. The patient’s surgical area should be free of dermatitis, wounds or other epidermal injuries. For diabetic patients, strict blood glucose control should be performed before surgery. Prevention of penile erectile dysfunction The prevention and treatment of ED is a holistic approach and should be based on the principle of individualization and comprehensive measures. Emphasis should be placed on related education for the male population and ED patients to target ED risk factors and take early intervention. Since most middle-aged and older men with ED are associated with atherosclerosis, hypertension, diabetes, etc., prevention of ED and prevention of cardiovascular disease are unified and mutually beneficial. In addition, it is necessary to take into account the close relationship between erectile function and various factors such as psychosocial, neurological, endocrine, urogenital diseases and trauma. The prevention goals and measures for ED are: for men with ED risk factors but normal erectile function, control the risk factors to reduce the possibility of ED; for men with reduced erectile function, early intervention to restore and protect erectile function; for men with erectile dysfunction, active treatment to achieve recovery of erectile function and improve the quality of sexual life. Among the preventive measures for ED, identifying and treating correctable causes, improving lifestyle habits, and controlling ED-related risk factors are most important. Evidence-based medical evidence supports the following preventive measures: 1. smoking cessation, physical activity and weight loss, and low-fat, high-fiber diet. 2, control of concomitant diseases, such as coronary heart disease, hypertension, diabetes, hyperlipidemia, metabolic syndrome, etc. 3.Regular sexual life can help improve erectile function. 4, the use of PDE5 inhibitors such as sildenafil early treatment of mild ED. ED prevention is of positive significance in patients who have undergone radical pelvic organ resection or radiotherapy for rectal cancer, prostate cancer, etc. Preservation of bilateral erectile nerves during radical prostatectomy and early daily low-dose continuous application of sildenafil or vacuum negative pressure device after surgery or radical radiotherapy can effectively prevent ED and promote the recovery of erectile function.