Vacuum Therapy in Erectile Dysfunction—Science and Clinical Evidence

J Yuan; A N Hoang; C A Romero; H Lin; Y Dai; R Wang


Int J Impot Res. 2010;22(4):211–219 

In This Article

VT under other Urological Conditions

In addition to its applications for ED and PR, VT has been expanded to other urological conditions. VED has been regarded as an initiator and enhancement of other ED therapies. Bellorofonte et al.[103] showed a synergistic action between intracavernosal vasoactive agents and VT. John et al.[26] combined VED with intra-urethral prostaglandin E1 to eliminate the need for constriction ring, with 100% successful rate in 19 patients. Cecchi et al.[104] evaluated VT with topical minoxidil in 18 patients and found that the combination enhanced the erection quality, reduced the time of device application and avoided 67% (12/18) the need for constrictive rings.

VED has also been used to preserve or restore natural potency. Oakley et al.[11] speculated that VED usage may delay the onset of intractable impotence in high-risk groups, such as those with diabetes and dyslipidemia. Colombo et al.[105] showed that daily VED with or without weekly intracavernosal papaverine (20 mg) injection for 6 months showed significant improvement in spontaneous erectile ability (VED only: 54% (14/26 patients); VED+papaverine: 65% (17/26 patients)). In addition, VED therapy has been shown to have penile length preservation effect in both non-NSRP and NSRP.[92] VED has also been successfully used in patients after penile prosthesis removal. Moul and Mcleod[106] reported 91% (10/11 patients) satisfactory erection and successful intercourse with the same or better length and circumference, compared with the previous natural erection. The authors attributed the prevention of penile scarring and shortening to the gradual resolution of corporeal scarring, with progressively improved blood flow into corporeal sinuses by the VED therapy. Lue and El-Sakka[107] have reported that chronic intermittent stretching with VED successfully lengthened the shortened penis due to severe Peyronie's disease after venous grafting in three patients. Lastly, anecdotal evidence from Oakley et al.[11] indicated that VED alone improved the size of both the flaccid and the erect state of the microphallus. However, a program of penile stretching with VED showed no statistically significant difference after 6 months of therapy; although it showed a 30% rate of patient satisfaction, probably due to psychological effect.[108]

Some VED derivatives have been invented. Gus'kov[109] in 2003 reported a combination of the vacuum effect along with vibration—the vibrovacuum fallostimulator named 'Sanos'. The author claimed that this new device reduced the exposure of the penis to the vacuum effect, thus preventing edema, hemorrhage and necrosis of the penile skin. He also claimed that this had an efficacy rate of 92.1% among 330 patients; however, no further confirmatory report has been found. Another version of VED is the EROS-CTD (Clitoral Therapy Device; UroMetrics Inc., St Paul, MN, USA), the only FDA approved mechanical treatment for female sexual dysfunction. This device causes clitoral vascular engorgement using a vacuum system.[110] Billups et al.[111] reported that a 3-month Eros therapy improved sensation (90%), vaginal lubrication (80%), orgasm (55%), and sexual satisfaction (80%) without adverse effects in 20 women with female sexual dysfunction. Wilson et al.[112] confirmed the results in 10 women with female sexual dysfunction. Schroder et al.[113] found that the Eros therapy significantly improved patients' arousal, lubrication, orgasm and desire among 11 women with cervical cancer treated with radiation therapy and sexual arousal and/or orgasmic disorder. Billups et al. showed similar results in terms of vaginal lubrication (92%) and orgasm (62%) for 13 women with female sexual dysfunction and diabetes.[114] Many women in this study also noted that after using the Eros therapy several times per week over a 2- to 3-month period, they continued to have improved vaginal lubrication, genital sensation or orgasms even without the device.