Mechanical treatment

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What is the vacuum device?

Vacuum Device TherapyThe vacuum device can be described as a safe, reliable, reversible, noninvasive method of achieving an erection. The concept of treating erectile dysfunction by creating a negative pressure to “pull blood into the penis” was first described back in 1874, but it wasn’t until 1974 that Osbon developed the first commercially available vacuum device. Although the device did not get FDA approval until 1982, by 1990 it was one of the most common recommended therapies for erectile dysfunction. Many vacuum devices were on the market, all using essentially the same technique but varying in their method of inducing the vacuum and in the constricting bands. Purchasing a vacuum device requires a prescription. There are several recognized companies that manufacture vacuum devices beside Osbon (which is now Timm), and these include Encore (Encore Inc., Louisville, KY), Mentor (Mentor Urology, Santa Barbara, CA), Post-T-Vac (Post-T-Vac Inc., Dodge City, KS), and Synergist (Synergist, Ltd., Houston, TX). Caution should be exercised in the purchase and use of similar devices advertised in magazines as sex aids because these devices may not have built-in pressure valves and may cause harm.

The function of the device is based on two principles: (1) a vacuum, or negative pressure, is generated to pull blood into the penis, and (2) a constriction device (ring) is used at the base of the penis to decrease venous drainage and thus prolong the erection. The vacuum device consists of a plastic cylinder, a pump that is either battery or hand operated, and a constrictive band(s) (Figure 9). The cylinder is wide enough and long enough to accommodate the erect penis. The cylinder is closed at the tip and open at the base. The constrictive bands are preloaded onto the base of the cylinder before its use.

Who is a candidate for the vacuum device?

Most men may use the vacuum device, and there are relatively few contraindications to its use. Men who have bleeding problems or who are taking blood thinners can use the vacuum device but must be careful. Men with Peyronie’s disease who have significant penile curvature may not be able to use the device because the erect penis may not fit in the cylinder. In such cases, corrective surgery to straighten the penis may be performed before the use of the vacuum device, or the man can try using the device and generating a less rigid erection. An uncooperative partner precludes the successful use of the device.

How does one use the vacuum device?

To use the vacuum device, the constricting band(s) is placed onto the base of the cylinder, and the cylinder is then placed over the penis and pressed firmly against the pubic bone to achieve an airtight seal (Figure 9). Suction is then applied by either a battery or a hand operated pump. When the penis is rigid, the band(s) is slipped off the cylinder onto the base of the penis. When intercourse is finished, the band is removed, and the blood drains out of the penis. The time taken to achieve an erection with the vacuum device varies but may be as short as 2 to 3 minutes. The band may be left on the penis for 30 minutes only. Most men are able to quickly learn how to use the device and become comfortable with using it within four practice sessions.

What is the success/satisfaction rate of the vacuum device?

The initial report on success of the vacuum device in 1985 reported a 90% success rate for achieving an erection that was adequate for sexual performance. Since that time, published success rates (i.e. the ability to have a rigid erection) with the vacuum device have varied from 84% to 95%, and overall satisfaction rates with the vacuum device vary from 72% to 94%. The vacuum device has been shown to be effective in treating various groups of men with erectile dysfunction of different causes. In patients with spinal cord injuries the success rate is reported to be 92%, and in those with psychogenic erectile dysfunction the device also yields good results. In men who have erectile dysfunction caused by arterial disease or after radical prostatectomy, the success rate is 90% to 100%. Furthermore, the device is successful in some men who were impotent after the removal of a penile prosthesis. Approximately 50% to 70% of individuals continue to use the vacuum device over the long term. Causes for discontinuation include causes unrelated to the device (e.g., return of spontaneous erections, loss of libido, or loss of partner) in 43%, and in 57%, the reason for discontinuation is related to side effects of the device or partner dissatisfaction.

Several studies have been performed that compared the vacuum device with other forms of treatment for erectile dysfunction. In a study of men who were using the vacuum device successfully and then tried Viagra, about one third of them preferred to resume the vacuum device rather than continue with the oral medication, citing that the vacuum device gave them a better quality of erection. In a study comparing intracavernosal therapy (injection therapy) with the vacuum device, there was a trend for younger patients who had a shorter period of erectile dysfunction to favor intracavernosal therapy.

How does Viagra compare to Vacuum Device therapy?

In a study comparing Viagra with the vacuum device, two thirds of men who were using the vacuum device successfully and then tried Viagra elected to continue using Viagra and to stop using the Vacuum device.

What are the side effects of the vacuum device?

Side effects of the vacuum device include:

  1. Penile coolness – with the vacuum device, penile skin temperature may decrease by 1°C.
  2. Penile skin cyanosis – congestion outside of the corpora may make the penile skin look blue. This resolves with removal of the band.
  3. Increased girth – the penile width after the vacuum device is actually wider than in a normal erection.
  4. Pain – this is the most common complaint, and it usually occurs when men are first starting to use the device. The pain may be related to the vacuum or to the constricting band.
  5. Discomfort during suction is noted in 20% to 40% of men using the vacuum device, primarily in men learning to use the device. The pain appears to decrease with continued use of the vacuum device and may be related to initial unfamiliarity with the device. Up to 45% of men have pain at the site of the constricting band. Again, this discomfort seems to improve with time and familiarity with the device.
  6. Ejaculatory troubles – pain with ejaculation is reported by 3% to 15% of men, and inability to ejaculate occurs in 12% to 30%.
  7. Penile bruising is noted in 6% to 20%.
  8. Numbness during erection occurs in 5%.
  9. Partner dissatisfaction ranges from 6% to 11%, with reasons for dissatisfaction cited as follows: unhappy with the performance, penile temperature, and penile appearance.
  10. Severe complications (serious, undesired results of a treatment) are uncommon, but they can occur. Ischemia (decreased blood flow) of the penis leading to necrosis can occur if the constricting band is left on too long. This is more of a problem in men with spinal cord injuries because they do not feel the discomfort related to the band. If the band is taken off within 30 minutes of application, the risk of penile ischemia is rare.