Vacuum-pump system (vacuum erection device, penile pump, penile vacuum device) has been used for a long time in patients with erectile dysfunction. Pump systems that were previously manually activated are now provided electronically. This system is widely used today because it is easy to use, inexpensive and has no serious side effects.

What is a vacuum erection device?

Vacuum erection (hardening) device is a system consisting of a cylindrical device and a rubber or silicone band that is placed on the root of the penis after the erection is created. Penile pump device has been used with nasari since 1985. The success rate is around 90%.

Who can use the vacuum device?

The vacuum device has a wide range of uses in andrology. The main uses are:

• All patients with erection problems
• Patients diagnosed with venous leakage
• Those who have damage to the penile nerve and therefore have erection problems
• Patients who use PDE5i (oral erection pills) and do not benefit from them
• Patients who have undergone surgery for prostate cancer, bladder cancer, large bowel (rectum) cancer

How is the vacuum device used/how does it work?

This device is very easy to use since it is not a very complicated system. The system can be easily used by the patient or their partner/spouse. The system is used as follows:

• The penis is placed inside the device/cylinder without any skin folds.
• Vacuum is created in the cylinder by removing the air inside the device by hand or with an electronic pump. In this way, an erection is achieved by filling the blood into the penis.
• After sufficient erection is created, the silicone ring in the cylinder urea is placed on the root of the penis, thus ensuring that the erection does not go out and lasts for a long time.
• After the ring is placed on the root of the penis, the ring is removed from the penis.
• The ring stays for a maximum of 30 minutes, after which the ring must be removed.

How long is the vacuum device used after an erection is created?

After activating the system and creating an erection, a plastic cylinder ring is placed on the root of the penis. In this way, the erection is not extinguished and the patient has intercourse. In an erection created in this way, the oxygen level in the blood drawn into the penis is lower than in a normal erection. This lack of oxygen can damage the penile skin in prolonged erections. For this reason, an erection should be maintained for a maximum of 30 minutes after the ring is placed.

At the end of 30 minutes, the ring at the root of the penis should be removed and the erection should be reduced. It is also very important that this ring must be made of flexible material. If rings made of inflexible, rigid, meat-like materials are used, they may eventually be difficult to remove. When we educate our patients, we especially remind them of these situations.

What are the points to be considered before using a vacuum device?

Although the system is very simple and does not have serious complications, some conditions should be considered before using it. The use of this system may lead to complications in those who use certain drugs and have diseases. Things to consider before using the vacuum device:

• Patients with previous priapism (prolonged erection)
• Those with Kamana problems
• Those with sickle cell anemia
• Patients taking blood thinners
• Those with impaired penile sensory perception
• Patients with spinal cord trauma
• Patients with penile curvature
• It should not be used in patients with open wounds in the application area.
• Those who have a bleeding disorder or a blood disease that causes clotting disorders

What is the price of the vacuum pump device, does SGK cover it?

The penis erection vacuum device is not very expensive. Depending on the company producing the product, the fee may also be different. We prefer the products of companies that produce Andrology-related products for our patients who will use this product. If the device is used carefully after it is purchased, it can be used for a long time without any serious problems.

Therefore, when the cost analysis is made, we can say that the price is quite affordable. Such products are not covered by SGK and private health insurances.

What are the benefits/advantages of a vacuum pump?

The widespread use of the vacuum pump system in Andrology has some advantages. The factors affecting the preference of a treatment method are the cost of the method, ease of use, absence of side effects or less. From this point of view, the vacuum system has many advantages.

• The cost is cheap
• It is an effective treatment
• Complications are negligible
• It is not an invasive method
• They can be used in combination with other treatment methods (ESWT, oral medications)
• No medication or injection is required for application.
• The cause of the erection problem is not important. It can be applied to any patient.

What are the side effects/complications of vacuum pump?

The vacuum pump system has no serious side effects or complications. When used consciously and carefully, it is possible to use it for a long time and without any problems. We can list some undesirable side effects of the vacuum system as follows:

• Pain
• Ecchymosis, bruising on the penile skin
• Numbness or cold feeling in the penis
• Redness on the skin of the penis (algea)
• The semen does not come
• May have orgasm problems
• Damage to the penile skin may occur if the ring is left on for more than 30 minutes.

Does using a vacuum enlarge the penis?

One of the frequently asked questions by patients is whether this system can be used to lengthen the penis and increase its thickness. The vacuum system has no effect on increasing the length of the penis. Again, this system does not have any strenuous effect on the thickness of the penis. In practice, we do not recommend the vacuum-pump system to lengthen the penis and increase the diameter of the penis. We recommend this system only to our patients who have erection problems.

It can be used in patients who have erection problems due to certain diseases (such as prostate cancer) to prevent shrinkage of the penis due to non-use.

Is the cause of erectile dysfunction important to use the vacuum device?

This system can be used by all patients with erectile dysfunction, there are no limitations. However, if there are situations where it is risky to use, caution should be exercised in these patients.

Can vacuum therapy be used with other treatments?

The vacuum device can be used in conjunction with other treatment methods in patients with erectile dysfunction. There is no obstacle in using the combination. There is no risk in using the penile pump system with oral medications, ESWT -shock wave therapy, injections into the penis, and gels squeezed into the urethra.

How often can use the vacuum pump?

There are no restrictions for the use of the vacuum device. Patients can use it whenever they want. The most important thing to note is that the elastic band application should not exceed 30 minutes.

Does age matter in a vacuum erection device?

There is no age limit for the use of the vacuum erection device. Patients of all ages with erectile dysfunction can use this system.

How does the vacuum device improve the erection?

Men with long-term erection problems (erectile dysfunction, ED, erectile dysfunction) develop regression due to lack of oxygenation in the inner part of the penis, development of scarring, fibrosis and shortening in the length of the penis over time.

For this reason, as a result of the use of the penile pump device at regular intervals (5-10 minutes a day) by patients who have erection problems, tissue oxygenation increases and structural problems in the inner part of the penile tissue are prevented and shortening in the penis length is prevented.

Information about the penile pump in the medical literature

• It is an effective treatment method for diabetic patients who do not respond to oral drug therapy (PDE5i) and those with erection problems.
• There are limited studies on the use of penile traction and vacuum device in the treatment of Peyronie’s disease. We generally do not use this method much.
• Patients with metabolic syndrome and associated erectile dysfunction can use this system.
• Patients receiving antiandrogen therapy due to radical prostatectomy or advanced prostate cancer can use it to solve the erection problem and prevent shortening of the penis neck.
• It can be used in patients who have had spinal cord (spinal cord) trauma and have erection problems.
• It can be used for penile rehabilitation after radical prostatectomy (open, robotic, laparoscopic), radical cystectomy, rectal cancer surgery.
• It can be used together with other treatment methods for patients with erection problems and for penile rehabilitation.
• It is possible to achieve a better erection by using oral pills (PDE5i) and a combined pump device in patients with nerve-sparing radical prostate cancer surgery.
• The combination of ESWT penile shock therapy and vacuum device is more effective in the treatment of erectile dysfunction in diabetics who do not respond to oral medications.
• It can be used in patients who have erectile dysfunction due to kidney failure and undergo dialysis.
• Vacuum therapy together with psychotherapy may be successful in patients with severe erectile dysfunction.
• It can be used as a treatment alternative in patients with neurological (related to penile nerve damage) erection problems.
• The satisfaction rate of couples using the vacuum device is high.
• Male use after radical prostatectomy (for penile rehabilitation) has yielded effective results.

As a result; Penile vacuum device is an effective and preferred method in patients with erection/hardening problems. It is a non-complicated, non-surgical, easy-to-use and inexpensive method without side effects. The most important advantage is that it can be used together with other treatments. We have been applying and recommending this treatment method to our patients for many years.

Prof. Dr. Emin OZBEK

Urology Specialist