The use of external vacuum therapy for the treatment of ED has been extensively reviewed in the past. Although vacuum devices can now be purchased over the counter, the senior author prefers prescription-only products. Some of the reasons for the preference of a prescription
device include better engineered device, more physiological tension rings, a variety of cylinders provided with some devices, and the availability of technical support staff, sometimes on a 24-hour call-in
line. Satisfaction from vacuum devices for the treatment of erectile dysfunction have been reported as low as 26.7% and as high as 94%, with drop-out rates from 20% to 30%.6,7 The reason for drop-out and complications are extensively discussed previously by this author. Even patients who have had penile prostheses in place and have had to remove them because of infection or patients who have severe penile fibrosis might benefit from vacuum therapy.5 The components of the vacuum system include the cylinder, a pump (manual or battery driven),
and the tension rings. Most of the tension rings must have tabs or strings to ease their removal after use of the vacuum device and there are even disposable tear-off tension bands. A variety of cylinder sizes with different inserts to adjust to different penile size are also available
on the prescription devices. A usual safety feature for most vacuum systems is that after a certain negative pressure is reached, there is a pop-off release valve. For use of the device the patient assembles the pump apparatus to the cylinder, the cylinder is pre-loaded with the tension bands, and then the cylinder is placed over the penis through its open end. Usually, water soluble lubricant helps seal the end of the cylinder against the infrapubic region. Once the vacuum is initiated, the penis becomes rigid and elongated with trapping of blood in all spaces of the penis. After this is achieved the tension band is placed around the base of the penis for intercourse and the cylinder is removed.
Because of fixation at the junction of the penis to the skin area there is sometimes a hinging of the penis that is normally not present with a full erection. The penis may also become slightly cool or numb. Pain with the
use of the device is extremely rare and is usually of a mild nature. With orgasm and ejaculation there may not be expulsion of fluid from the penis because of the tension band. It is recommended that the tension bands not be left in place for greater than 30 minutes. The treatment modalities for organic erectile dysfunction range from inexpensive and non-invasive to very expensive and highly invasive. A patient and his physician may find that only one of these treatment options best
serves the specific needs of the patient and his partner. This choice should be made in the context of full knowledge of all options – and that certainly means positioning vacuum therapy devices as one of the primary options to discuss.