Traction and vacuum devices

Abstract INTRODUCTION: Conservative treatment for penile curvature in Peyronie’s disease (PD) by means of penile stretching is attractive compared to the available invasive treatments with risks for complications and failure. Therefore, penile stretching using penile traction therapy (PTT) or vacuum erection devices (VED) are used widely in the medical as well as in the commercial circuit. VED and PTT can be used in PD as stand-alone therapy and in combination with intralesional therapy. Many experimental and clinical studies have been conducted to assess the mechanism and effectivity of PTT and VED, however, clear guidelines are not yet available. METHODS: A PubMed search was performed of publications on PTT and VED in men with PD from inception through May 2019. RESULTS: PTT has been successful in primary penile lengthening and curvature correction in the acute phase of PD in vitro and in vivo studies. The duration and rhythm of its use appears to be of importance for optimal changes in penile curvature, length and girth. After surgical correction of PD, PTT has been shown to be effective in preserving penile length. The combination of PTT and intralesional injection therapies for PD treatment requires further investigation as the available clinical data are both contradictory and limited. There are fewer studies investigating VED and their role in PD management, but initial small trials suggest a role in curvature correction and penile lengthening as well. CONCLUSIONS: Penile stretching can be very effective in PD. Data suggest a role for PTT and VED in the management of PD as sole therapy, after surgery and during intralesional injection therapy. Further research is needed to be able to provide physicians with clarity about the optimal ways to deploy traction therapy in combination with other treatment options, and with guidelines for the most effective timing and duration of the use of the available traction devices.