The 3-cylinder (SOMA) vacuum device has been recommended as a non-surgical treatment for Peyronie’s disease. My personal approach has been to start with the largest cylinder so as to accommodate the curvature when it first presents. As the curvature and deformity responds to the pressures created by the vacuum tube, one should progressively go to the middle and then the smallest of the caliber cylinders. I typically recommend that this progression occur after at least one month of use of each cylinder, which should be applied for 20-30 minutes at least once, but possibly better 2-3 times per day. There is no need to apply the constriction band. I recommend that the pressure be maintained throughout the 20-30 minute treatment period rather than using a repetitive inflate/deflate process. It seems to me the effects of traction are best transmitted with prolonged application rather than with intermittent application. So far there are no published reports showing benefit with traction therapy, but hopefully a formal trial will be conducted in the near future which will provide better insight as to whether vacuum therapy really works to correct PD deformity.