During prostatic radiotherapy, damage to several anatomical structures could be the cause of erectile dysfunction: corpora cavernosa, internal pudendal arteries, penile bulb, and neurovascular bundles. Numerous studies have analysed the correlations between the dose received by these structures and erectile function. The objective of this article is to make a systematic review on current knowledge.
A systematic review was performed in the Medline database using the search engine PubMed. Keywords for the search included: erectile dysfunction, penile bulb, corpora cavernosa, cavernosum, neurovascular bundles, radiation therapy, cancer, prostate cancer. The selected articles must study a correlation between erectile dysfunction and the dose received by anatomical structures. A total of 152 articles were identified. Of these 152 articles, 45 fulfilled the defined selection criteria.
For corpora cavernosa, seven studies were identified, only two studies demonstrated a significant correlation between the dose received by corpora cavernosa and the occurrence of erectile dysfunction. For penile bulb, only 15 of 23 studies showed a correlation. A mean dose on the penile bulb greater than 20Gy was found to be predictive of erectile dysfunction. None of the eight trials concerning neurovascular bundles succeeded to show a correlation between dose and erectile dysfunction. Only one study evaluated the relationship between the dose received by internal pudendal arteries and erectile dysfunction but was found to be negative. However, vessels-sparing studies showed good results on erectile function preservation without compromising the target volume.
We currently have little data to show a correlation between erectile dysfunction and sexual structures. It would be necessary to have additional prospective studies evaluating the impact of an optimization on these sexual structures on erectile dysfunction.
Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique. 2023 Aug 16 [Epub ahead of print]
A Ailloud, C Udrescu, S Horn, C Enachescu, G Créhange, P Sargos, S Supiot, T Zilli, A Lapierre, O Chapet
Département de radiothérapie-oncologie, hôpital Lyon-Sud, Pierre-Bénite, France., Département de radiothérapie-oncologie, hôpital Lyon-Sud, Pierre-Bénite, France; Université Claude-Bernard Lyon 1, Pierre-Bénite, France., Département de radiothérapie-oncologie, institut Curie, Paris, France; Université PSL, université Paris-Saclay, U1288, Inserm Lito, Orsay, France., Département de radiothérapie-oncologie, institut Bergonié, Bordeaux, France., Département de radiothérapie-oncologie, institut de cancérologie de l'Ouest, centre René-Gauducheau, Saint-Herblain, France., Département de radiothérapie-oncologie, hôpitaux universitaires de Genève, Genève, Suisse; Université de médecine de Genève, Genève, Suisse., Département de radiothérapie-oncologie, hôpital Lyon-Sud, Pierre-Bénite, France; Université Claude-Bernard Lyon 1, Pierre-Bénite, France. Electronic address: .