Generally, hypoxia is a normal physiological condition in the flaccid penis, which is interrupted by regular nocturnal erections in
men with normal erectile function.1 Lack of spontaneous and nocturnal erections after radical prostatectomy due to neuropraxia
results in persistent hypoxia of cavernosal tissue, which leads to apoptosis and degeneration of cavernosal smooth muscle fibers.
Therefore, overcoming hypoxia is believed to play a crucial role during neuropraxia. The use of a vacuum erectile device (VED) in
penile rehabilitation is reportedly effective and may prevent loss of penile length. The corporal blood after VED use is increased and
consists of both arterial and venous blood, as revealed by color Doppler sonography and blood gas analysis. A similar phenomenon
was observed in negative pressure wound therapy (NPWT). However, NPWT employs a lower negative pressure than VED, and a
hypoperfused zone, which increases in response to negative pressure adjacent to the wound edge, was observed. Nonetheless,
questions regarding ideal subatmospheric pressure levels, modes of action, and therapeutic duration of VED remain unanswered.
Moreover, it remains unclear whether a hypoperfused zone or PO2 gradient appears in the penis during VED therapy. To optimize a
clinical VED protocol in penile rehabilitation, further research on the mechanism of VED, especially real‑time PO2 measurements
in different parts of the penis, should be performed.

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