Correlation Between Erectile Dysfunction and Dose to Penile Bulb and Neurovascular Bundles Following Prostate Brachytherapy

Solan, A.N.; Stock, Richard G.; Cesaretti, Jamie A.; Stone, Nelson N.

doi:10.1016/j.ijrobp.2007.07.1440

Cited by 1 publication

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“…Clinical studies of RT-induced ED have found decreased penile blood flow, suggesting vascular injury as a cause [6][7][8]. More direct understanding has been elusive, as neurovascular bundle irradiation and dose to the penile bulb and associated vasculature have inconsistently been found to be associated with ED in RT patients [9][10][11][12][13][14][15]. Considering the frequency of RT-induced ED, better understanding of its etiology is needed in order to develop an effective prevention strategy.…”

Section: Introductionmentioning

confidence: 99%

Radiation-Induced Erectile Dysfunction Using Prostate-Confined Modern Radiotherapy in a Rat Model

Kimura

Yan

Rabbani

et al. 2011

The Journal of Sexual Medicine

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Introduction The mechanisms of radiation-induced erectile dysfunction (ED) are unclear, as clinical studies are limited, and previous animal models were based on wide-field irradiation, which does not model current radiotherapy (RT) techniques. Aims To perform functional and morphological analyses of erectile function (EF) utilizing image-guided stereotactic prostate-confined RT in a rat model. Methods Sixty young adult male rats aged 10–12 weeks old were divided into age-matched sham and RT groups. A single 20-Gy fraction to the prostate was delivered to RT animals. Penile bulb, shaft, and testes were excluded from treatment fields. Main Outcome Measures Bioassay and intracavernous pressure (ICP) measurements were conducted at 2, 4, and 9 weeks following RT. Perfusion analysis of the corpora cavernosa (CC) was conducted using Hoechst injected prior to sacrifice. Penile shaft and cavernous nerve (CN) were evaluated by immunohistochemistry. Plasma testosterone level was analyzed using a testosterone enzyme-linked immunosorbent assay (ELISA) assay kit. Results Irradiated animals demonstrated statistically significant time-dependent functional impairment of EF by bioassay and ICP measurement from 4 weeks. Neuronal nitric oxide synthase (NOS) expression was decreased in CN by 4 weeks. In CC, expression levels of anti-alpha smooth muscle actin and endothelial NOS were significantly decreased at 9 weeks. In penile dorsal vessels, smooth muscle/collagen ratio was significantly decreased at 4 and 9 weeks. Additionally, Hoechst perfusion showed time-dependent decrease in CC of RT animals, whereas CD31 expression was not affected. No toxicities were noted; testosterone levels were similar in both groups. Conclusion We demonstrated time-dependent ED following image-guided stereotactic RT. Our results imply that reduction of neuronal NOS expression in cavernous nerve could trigger consecutive reduction of smooth muscle content as well as blood perfusion in CC that resulted in corporal veno-occlusive dysfunction. Present study could be a cornerstone to future research that may bring comprehensive scientific understanding of radiation-induced ED.

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