Penile traction therapy after radical pelvic surgery: Does it work?

Abstract Sexual dysfunction, including erectile dysfunction and penile shortening, is a frequent consequence of radical pelvic surgeries such as prostatectomy, cystoprostatectomy, and rectal cancer surgery. These complications primarily result from nerve injury and hypoxia‐induced corporal fibrosis. As survivorship care gains prominence in oncology, preserving sexual function and penile anatomy has become a critical objective. Penile traction therapy (PTT) is a non‐invasive intervention that applies controlled mechanical stretch to the penis. Through mechanotransduction, PTT may stimulate tissue remodeling, preserve length, and reduce fibrosis. Initially developed for Peyronie's disease, PTT is now being explored for penile rehabilitation following pelvic surgery. Preliminary clinical studies, including randomized controlled trials, suggest that early initiation of PTT may help maintain or even improve penile length and erectile function (EF). Treatment is generally well tolerated, with high adherence and minimal side effects. The advent of second‐generation devices, offering enhanced ergonomics and reduced daily usage times, has further improved feasibility and patient compliance. This review outlines the pathophysiological basis of post‐surgical penile changes, the mechanism of action of PTT, and the emerging evidence base for its use in the post‐oncological setting. Although PTT use remains off‐label in this context, it represents a promising component of multimodal penile rehabilitation strategies. Its broader adoption is currently limited by barriers such as device cost, lack of insurance coverage, and the absence of standardized protocols. Structured follow‐up, patient education, and multicenter long‐term studies are essential to validate efficacy, establish best practices, and optimize accessibility for patients recovering from radical pelvic surgery.