Stember Doron S, Mulhall John P
Department of Urology, Beth Israel Medical Center, New York, NY, USA.
Brachytherapy. 2012 Mar-Apr;11(2):87-96. doi: 10.1016/j.brachy.2012.01.002. Epub 2012 Feb 11.
Radiation therapy (RT) for prostate cancer is commonly associated with erectile dysfunction (ED), although high-quality data on incidence of ED after brachytherapy (BT) are limited. We reviewed the literature on BT-related ED and propose a clinical pathway for maximal preservation of erectile function (EF) after treatment.
Erectile physiology and pathophysiology after RT are reviewed. Evidence and rationale for the concept of penile rehabilitation are presented. BT literature that focuses on ED is identified. A clinical care pathway for maximally preserving EF in patients treated with RT for localized prostate cancer is proposed.
The mechanisms contributing to ED after prostate irradiation involve injury to the neurovascular bundles, penile vasculature, and cavernosal structural tissue. Reported rates of ED after BT vary widely. Basic science and clinical studies support the concept of a structured program of erectile tissue preservation for optimizing EF after radical prostatectomy and are adapted for the prostate radiation patient.
Although definitive evidence for such erectile tissue preservation strategies is pending, there is a solid scientific rationale for the application of available strategies to the radiation patient.
前列腺癌的放射治疗（RT）通常与勃起功能障碍（ED）相关，尽管关于近距离放射治疗（BT）后ED发生率的高质量数据有限。我们回顾了关于BT相关ED的文献，并提出了一种临床路径，以在治疗后最大程度地保留勃起功能（EF）。
回顾了RT后勃起的生理学和病理生理学。阐述了阴茎康复概念的证据和理论依据。确定了关注ED的BT文献。提出了一种临床护理路径，用于在接受RT治疗局限性前列腺癌的患者中最大程度地保留EF。
前列腺照射后导致ED的机制涉及神经血管束、阴茎血管系统和海绵体结构组织的损伤。报道的BT后ED发生率差异很大。基础科学和临床研究支持为根治性前列腺切除术后优化EF而制定的结构化勃起组织保留方案的概念，并适用于前列腺放疗患者。
尽管此类勃起组织保留策略的确切证据尚待确定，但将现有策略应用于放疗患者有坚实的科学依据。
