Radical pelvic surgeries, including prostatectomy, cystoprostatectomy, and rectal cancer surgery, save lives but often come with significant sexual side effects. Many men experience erectile dysfunction and noticeable penile shortening after these procedures. These issues arise mainly from nerve injury and reduced oxygen supply to penile tissues, which can lead to fibrosis and loss of smooth muscle.

Penile traction therapy applies gentle, controlled stretching to the penis. Through a process called mechanotransduction, this mechanical force stimulates tissue remodeling, reduces fibrosis, and may preserve erectile function. The biological pathways involved in preventing cavernosal fibrosis are illustrated in FIGURE 1. At the molecular level, traction therapy upregulates enzymes that break down fibrotic tissue, such as matrix metalloproteinases (MMPs), while suppressing pro-fibrotic factors like transforming growth factor-beta 1 (TGF-β1). This shift helps reduce collagen buildup and supports the survival of smooth muscle cells within the penis.

Several commercial PTT devices are now available, including Penimaster PRO, Andropenis, Andropeyronie, and RestoreX (FIGURE 2). Newer second-generation devices, such as RestoreX, require only 30–60 minutes of daily use, making them much easier for patients to adhere to compared to older devices that needed several hours each day.

Clinical evidence supports the benefits of early PTT. In a randomized controlled trial of 82 patients after prostatectomy, those who started PTT one month after surgery and used it daily for 30–60 minutes over six months showed significantly better penile length preservation (1.6 cm gain vs. 0.3 cm in controls) and stable erectile function scores, while control patients experienced a 6.5-point decline. Treatment adherence exceeded 85%, and side effects were mild, including temporary penile redness and discomfort.

A follow-up study further confirmed that starting PTT early is critical. Patients who began treatment one month after surgery gained an average of 1.7 cm in penile length and had minimal decline in erectile function. In contrast, those who delayed treatment until six months after surgery gained only 0.5 cm and had a significant drop in erectile function scores.

Currently, PTT is not yet formally approved for use after pelvic cancer surgery; most devices are FDA-cleared only for Peyronie‘s disease. Cost, lack of insurance coverage, and limited access remain barriers to wider use.

The findings offer a clear answer to whether penile traction therapy works after radical pelvic surgery: current evidence supports its role in preserving penile length and improving erectile function, particularly when started early. However, standardized protocols and more high-level studies are still needed. The work titled “Penile traction therapy after radical pelvic surgery: Does it work?” was published on UroPrecision (published on 30 December 2025).

doi:10.1002/uro2.70043