What standardized VED schedules (duration/frequency) have the best evidence for preserving penile length after radical prostatectomy?

1. The regimen that carries the best evidence: short daily sessions started early

The clearest randomized and prospective data test protocols of approximately 10 minutes daily started early in the postoperative period (within days to 1 month after catheter removal or surgery) and continued for weeks to months; these regimens were associated with significantly less stretched penile length loss versus controls in several small trials and pilot studies (daily 10 min/day or daily sessions for 90 days), with one randomized trial showing benefit for 10 minutes daily over 6 months and nonrandomized series showing preserved length when VED was used on >50% of possible days ^{[1] [2] [8]}.

2. Why "10 minutes daily" became a common recommendation

Multiple small RCTs and clinical reviews adopted 10-minute daily sessions as a pragmatic tradeoff between biological plausibility and patient tolerability: a controlled trial by Köhler and colleagues and follow-up translational reviews cite 10 minutes/day as the tested protocol that maintained stretched penile length without constriction rings, and later commentaries and book chapters have propagated that schedule because it produced measurable SPL preservation in short trials ^{[1] [9] [3]}.

3. Evidence that timing and adherence drive outcomes, not just device use

Systematic reviews and pooled analyses underline two consistent modifiers: earlier initiation (within weeks versus waiting months) and better adherence (for example, using the device on >50% of days) correlate with improved length preservation and erectile outcomes; programs that actively support compliance yield stronger results than ad‑hoc prescriptions, indicating behavioral factors strongly influence measured benefit ^{[4] [2] [3]}.

4. Mechanistic and adjunctive context: why VED might work and what else helps

Basic science and translational reviews describe plausible mechanisms — increased arterial inflow, anti‑hypoxia, anti‑fibrotic and anti‑apoptotic effects on corporal tissue — that support early, repeated mechanical distension as protective after cavernous nerve injury; clinical reports also show that regular PDE5 inhibitor use and other rehabilitation strategies can moderate penile shortening, so VED is frequently considered part of a multimodal program rather than a lone cure ^{[5] [9] [7] [10]}.

5. Limits, inconsistencies, and alternative findings

The evidence base is not large or uniform: many trials are small, nonblinded, use different endpoints and timing, and some studies found minimal or no preservation effect after VED compared with controls; long‑term natural recovery of penile length over 2–4 years complicates interpretation of short-term gains, and systematic reviews emphasize that high‑quality, large RCTs comparing specific standardized schedules are still lacking ^{[2] [6] [4] [10]}.

6. Practical synthesis and the honest conclusion from current studies

The best-evidenced, standardized VED schedule for minimizing postoperative penile shortening is initiation early (within days to about one month postoperatively) with short daily sessions — commonly 10 minutes per day — continued for at least 3 months and often up to 6 months, with demonstrated benefit tied to adherence; however, clinicians and patients must weigh modest trial sizes, heterogeneity, and the role of adjunctive PDE5 inhibitors, and recognize that longer-term recovery may occur independently over years ^{[1] [2] [3] [6] [7] [4]}.