Radical prostatectomy (RP) is a treatment for localized prostate cancer. Despite advanced surgical techniques, erectile dysfunction (ED) remains a common side effect. ED occurs because the delicate cavernous nerves responsible for erections are often damaged or temporarily stunned during the procedure. A vacuum erection device (VED) offers a non-invasive, mechanical strategy to manage this side effect. VEDs serve as a restorative tool used to promote penile health and function during post-operative recovery.
Why VEDs Are Used for Penile Rehabilitation
The primary purpose of VED use after radical prostatectomy is penile rehabilitation. Following surgery, the lack of frequent, natural erections reduces blood flow and oxygenation within the erectile tissue, a state called corporal hypoxia. This low-oxygen environment triggers corporal tissue atrophy, which replaces flexible smooth muscle with stiff, non-elastic scar tissue (fibrosis). Fibrosis can cause penile shrinkage and lead to venous leakage, making it difficult to maintain an erection. VED therapy actively combats this process by artificially stretching and oxygenating the tissue.
VEDs draw oxygenated blood into the corpora cavernosa, the erectile tissue chambers. This regular engorgement reverses tissue hypoxia, preventing scar tissue and preserving the tissue’s elasticity and structure. By maintaining tissue health until injured nerves recover, the VED supports the return of spontaneous erectile function. Early use may also help preserve penile length and improve erectile function recovery.
How the Vacuum Erection Device Functions
A VED is a mechanical system composed of three main parts. The first is a clear plastic cylinder, placed over the penis and sealed against the pubic bone. This cylinder connects to a pump mechanism, which is either manual or battery-powered.
The pump generates negative pressure within the cylinder. This vacuum effect causes blood to rush into the penis, resulting in engorgement. This process draws both arterial and venous blood into the erectile chambers, increasing tissue oxygenation.
The third component is the tension band, or constriction ring, a flexible ring placed at the base of the penis. This ring acts as an artificial valve, preventing trapped blood from flowing back out and maintaining the erection after the cylinder is removed. Achieving an erection typically takes between 30 seconds and seven minutes.
Practical Guidelines for Starting and Using VED Therapy
VED therapy is typically recommended by a surgeon or urologist, starting early in the post-operative period. Most protocols suggest beginning VED use between two and six weeks following radical prostatectomy, usually after the Foley catheter is removed.
The protocol for penile rehabilitation differs from using the device for sexual intercourse. For rehabilitation, the VED is used without the constriction ring to ensure transient blood flow and oxygenation. A common regimen involves using the device daily or every other day for sessions lasting 10 to 15 minutes.
During rehabilitation, the goal is to achieve an erection five times, holding the vacuum for about two minutes per erection. Preparation requires applying a water-soluble lubricant to the base of the penis and the cylinder rim for an airtight seal. Pumping should be done slowly to avoid pain, stopping when the penis is full and taut, but not uncomfortable.
When used for sexual activity, the constriction ring is applied to the base of the penis once a firm erection is achieved to sustain rigidity for penetration. The ring must be placed before removing the cylinder and must be removed immediately after sexual activity.
Expected Results and Safety Considerations
The recovery of spontaneous erectile function is a gradual process that can take up to two years. While VEDs improve the ability to have successful intercourse when used with the constriction ring, their primary benefit in rehabilitation is preserving penile tissue health. VED use is associated with a lower likelihood of penile shrinkage and can improve early sexual function scores.
The device is generally safe, but minor side effects are common. These include small, pinpoint red spots (petechiae), slight bruising, or numbness or coldness in the penis. Some men may also experience difficulty with ejaculation or discomfort due to the constriction ring preventing semen flow. These side effects are usually temporary and diminish with continued use.
The most important safety consideration is the duration the constriction ring remains in place. The ring should never be left on for more than 30 minutes, as prolonged use can lead to tissue damage, discoloration, and injury from lack of blood flow. Patients should contact their physician if they experience severe pain, persistent numbness, or signs of a serious adverse reaction.