What clinical protocols recommend VED use for penile rehabilitation after prostatectomy and how do they describe pressure and timing?

1. Which guideline‑style protocols actually recommend early VED use

Multiple clinical trials and narrative reviews support integrating VED into postoperative penile‑rehabilitation regimens and recommend starting VED therapy “early” — often within weeks of surgery or soon after catheter removal — as part of multimodal rehabilitation alongside PDE5 inhibitors or as an alternative for men who cannot use drugs ^{[5] [6] [1]}. Randomized and prospective studies cited in the literature assigned patients to daily VED use versus observation and reported preservation of penile length and some functional benefit, which is why VED appears in practice‑pattern surveys and recommendations from urologic centers ^{[1] [7] [8]}.

2. How published protocols describe timing and session duration

The most consistent, trial‑based timing is short, daily sessions: several randomized or prospective studies used 10 minutes per day of VED use for periods ranging from months to nine months (notably a 10 min/day protocol in Köhler and in a Thai randomized trial) and observed preservation of stretched penile length and improved intermediate erectile scores ^{[7] [1]}. Other pragmatic sources vary: some consumer guidance suggests 5–10 minutes two times per week as a low‑intensity option while rehabilitation‑oriented programs and specialist blogs recommend daily use for the first 2–3 months and even up to 6–9 months to mirror the nerve‑recovery window ^{[9] [10] [1]}. Reviews stress that “early” often means initiating therapy in the immediate postoperative period (some studies began after catheter removal), because early intermittent engorgement may reduce hypoxia‑driven fibrosis ^{[6] [10]}.

3. How protocols describe pressure (negative pressure) settings

Clinical papers commonly quantify VED vacuum as a negative pressure of roughly 150–200 mmHg created by the pump; that range is repeatedly cited as the mechanism by which VED increases arterial inflow and penile oxygenation ^[2]. At the same time, dedicated reviews explicitly flag that ideal subatmospheric pressure levels have not been definitively established and call for physiologic studies (including real‑time tissue PO2 measurements) to optimize pressure prescriptions and avoid hypoperfused zones ^[3]. Practical guidance therefore often leaves final vacuum intensity to patient comfort and device limits within the broadly reported 150–200 mmHg range ^{[2] [3]}.

4. Caveats, controversies and real‑world practice

High‑quality long‑term randomized evidence remains limited and results are mixed regarding VED’s effect on long‑term natural erectile recovery, so recommendations rely on short‑ to medium‑term trials and pathophysiologic rationale (anti‑hypoxic, anti‑apoptotic, anti‑fibrotic) rather than definitive outcomes across years ^{[11] [4]}. Practice surveys show many urologists favor PDE5 inhibitors as first‑line with VED as an adjunct or second‑line, influenced by cost, tolerability and patient preference ^[8]. Reviews also caution against routine use of constriction rings during rehabilitation because prolonged band use lowers tissue oxygen saturation; ring use is reserved for intercourse rather than daily rehabilitation sessions ^[12].

5. Bottom line for protocol content and limits of the evidence

Clinical protocols that favor VED after prostatectomy converge on early initiation, brief daily sessions (commonly 10 minutes/day) continued for months, and vacuum settings in the neighborhood of 150–200 mmHg; nonetheless, authoritative reviews emphasize unanswered questions about optimal pressure, precise timing/frequency and long‑term benefit, and recommend individualized counseling and further trials to standardize protocols ^{[1] [2] [3] [4]}.