How effective are postoperative vacuum and traction protocols in randomized or prospective comparative studies after IPP placement?

1. What the randomized and prospective trials actually show about length outcomes

Small randomized or prospective comparative studies report that early, regular VED or PTT use is associated with maintenance—or modest gains—of stretched/erect penile length compared with delayed or no use: a 28‑patient randomized pilot trial found early daily VED preserved stretched penile length (SPL) while delayed or on‑demand use resulted in an average ~2 cm loss (Kohler et al.) ^[1], and a single‑center prospective cohort of 74 men receiving six months of postoperative VED after AMS LGX 700® IPP reported penile dimension maintenance and high satisfaction at one year ^{[2] [7]}. Other prospective programs combining preoperative traction or vacuum preparation with intraoperative techniques report measurable postoperative length gains in many patients—one group reported 70% with measured erectile length gain up to 1.5 cm after preoperative traction protocols ^{[8] [9]}.

2. What randomized trials say about function and the limits of rehabilitation claims

High‑level randomized controlled trials to date have consistently failed to show that VED/PTT preserves or restores spontaneous erectile function after prostate surgery, and at least one rehabilitation RCT closed early for poor accrual without benefit from PDE‑5 or intracavernosal regimens—findings echoed in randomized PTT work that improved length but not spontaneous erectile recovery ^{[4] [3]}. Systematic reviews of early VED use after radical prostatectomy conclude that therapeutic benefit for erectile function is unproven and emphasize limited methodological quality across studies ^[5].

3. Why the evidence is not definitive: heterogeneity, sample size and protocol variation

The published trials differ markedly in timing (preoperative vs early postoperative), dose (minutes to hours per day, weeks to months of use), device type, outcome measures (stretched vs erect length; patient perception vs objective measurement) and sample selection—issues repeatedly highlighted in narrative and systematic reviews and in the field’s calls for standardization ^{[1] [5] [6]}. Many reports are small single‑center trials, pilot studies or noncontrolled cohorts, so effect estimates are imprecise and prone to selection and adherence biases ^{[3] [10]}.

4. Practical interpretation and the research agenda ahead

Taken together, the best current randomized/prospective evidence supports that disciplined VED or traction protocols can mitigate perceived and measured penile shortening after IPP placement or prostatectomy in selected cohorts, but they do not salvage spontaneous erectile function, and magnitude of benefit is modest and variable across studies ^{[1] [2] [3] [4]}. Major urology systematic reviews and recent analyses therefore urge larger, multicenter randomized trials with standardized devices, defined dosing regimens, objective length metrics and longer follow‑up to determine who benefits, for how long, and whether combinations with surgical techniques change outcomes ^{[5] [6] [11]}. Until such data arrive, these protocols can be presented to patients as a reasonable option to reduce postoperative length complaints in motivated individuals, with explicit caveats about limited high‑quality evidence and uncertain effects on erectile function ^{[8] [12]}.