Radical prostatectomy has been shown to have a potential negative impact on penile health. Stretched penile length (SPL), which most closely correlates with erect penile length, was significantly reduced in almost half of men undergoing surgery in several studies. The purpose of this study was to test whether early intervention after surgery with a vacuum erection device could prevent the changes in penile health, as defined by SPL, found in prior studies. Forty-two men with good preoperative sexual function undergoing nerve-sparing radical prostatectomy underwent measurement of SPL preoperative and at 3 months postoperative by a single investigator. Daily use of a vacuum erection device (VED) was begun the day after catheter removal, and continued for 90 days. Men kept a log of their compliance with daily VED use. A decrease in SPL of ⩾1.0 cm was considered significant. Out of 42 men, 39 completed the study. In men who used the VED >50% of possible days, only 1/36 (3%) had a decrease in SPL of ⩾1.0 cm. Of the three men with poor VED compliance, two (67%) had a reduction in SPL of ⩾1.0 cm. When compared to prior studies where 48% of men after surgery had a significant reduction in SPL, early intervention with the daily use of a VED resulted in a significantly lower risk of loss of penile length (P<0.0001). For men wishing to preserve penile health/length after surgery, early intervention with the daily use of a VED should be strongly recommended.
This is a preview of subscription content
Subscribe to Journal
Get full journal access for 1 year
only $14.88 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
Munding M, Wessells H, Dalkin B . Pilot study of changes in stretched penile length 3 months after radical retropubic prostatectomy. Urology 2001; 58: 567–569.
Savoie M, Sandy S, Soloway M . A prospective study measuring penile length in men treated with radical prostatectomy for prostate cancer. J Urol 2003; 169: 1462–1464.
Fraiman M, McCullough A, Lepor H . Changes in penile morphometrics in men with erectile dysfunction after nerve-sparing radical retropubic prostatectomy. Mol Urol 1999; 3: 109–115.
Wessells H, Lue T, McAninch J . Penile length in the flaccid and erect states: guidelines for penile augmentation. J Urol 1996; 156: 995–997.
Mulhall JP . Penile length changes after radical prostatectomy. BJU Int 2005; 96: 472–473.
Dall'Era J, Mills J, Koul H, Meacham R . Penile rehabilitation after radical prostatectomy: important therapy or wishful thinking? Rev Urol 2006; 8: 209–215.
Bosshardt R, Farwerk R, Sikora R, Sohn M, Jakse G . Objective measurement of the effectiveness, therapeutic success and dynamic mechanisms of the vacuum device. Br J Urol 1995; 74: 786–791.
Carrier S, Zvara P, Nunes L, Kour NW, Rechman J, Lue T . Regeneration of nitric oxide synthase-containing nerves after cavernous nerve neurotomy in the rat. J Urol 1995; 153: 1722–1777.
Klein L, Miller M, Buttyan R, Raffo AJ, Burchard M, Devris G et al. Apoptosis in the rat penis after penile denervation. J Urol 1997; 158: 626–630.
User H, Hairston JZelner D, McKenna K, McVary K . Penile weight and cell subtype specific changes in a post-radical prostatectomy model of erectile dysfunction. J Urol 2003; 169: 1175–1179.
Raina R, Agarwal A, Ausmundson S, Lakin M, Nandipati KC, Montague DK et al. Early use of the vacuum constriction device following radical prostatectomy facilitates early sexual activity and potentially earlier return of erectile function. Int J Impot Res 2006; 18: 77–81.
Padma-Nathan H, McCullough A, Giuliano F, Toler S, Wohlhuter C, Shpilsky A et al. Postoperative nightly administration of sildenafil citrate significantly improves the return of normal spontaneous erectile function after bilateral nerve-sparing radical prostatectomy (abstract 1402). J Urol Vol 2003; 169: 375.
Penile health study: use of the VED
Assemble the handle to the tube with the writing on the tube facing up, and the lever on the handle facing down.
Put lubricant in the bottom of the tube where your penis will be, then around the outside edge of the tube where it will contact your skin.
You may need to trim the pubic hair at the base of the penis to give a better seal for the tube.
Use the pump either standing up or sitting forward on the edge of a chair to allow the scrotum skin to hang down out of the way.
Gently but firmly compress the tube against yourself to create a nice seal to then begin pumping.
Begin pumping by compressing the handle once every several seconds to allow for a slow engorgement of the penis.
Continue until the penis is fully engorged, usually when it elevates off the floor of the cylinder and is in the middle of the tube.
Leave the penis fully engorged inside the pump for 5 min. Then let the penis deflate fully for 1–2 min and repeat to full engorgement for another 5 min.
Perform daily beginning the day after your catheter is removed from your bladder.
There is a safety regulator in the system that prevents you from creating too much pressure to injure yourself.
Feel free to use the VED for sexual intercourse as well. This involves the use of the constriction bands, which is reviewed in the manual with the VED.
About this article
Cite this article
Dalkin, B., Christopher, B. Preservation of penile length after radical prostatectomy: early intervention with a vacuum erection device. Int J Impot Res 19, 501–504 (2007). https://doi.org/10.1038/sj.ijir.3901561
- prostate cancer
- erectile dysfunction
- vacuum erection device
Nature Reviews Urology (2022)
Current Sexual Health Reports (2019)
Optimizing veteran-centered prostate cancer survivorship care: study protocol for a randomized controlled trial