Managing Erectile Dysfunction After Pelvic Radiotherapy

Radiotherapy (RT) is an integral component of various multidisciplinary treatment approaches for pelvic malignancies, used both in the radical and adjuvant setting. Despite the improvement of radiotherapy modalities, pelvic radiotherapy often induces permanent erectile dysfunction (ED). However, post-treatment ED receives little medical attention, since patient follow-up focuses mainly on cancer recurrence surveillance. The present review aims to summarize the current treatment modalities against radiation-induced erectile dysfunction (RIED) for patients who have received pelvic radiotherapy.

A literature review on emerging treatment strategies for RIED was conducted to summarize existing evidence. Research in medical literature was conducted through the PubMed Central databases, from 1996 up until June 2024, in the English language. All relevant clinical trials on RIED management were included.

The efficacy of PDE5i was investigated by 12 research studies. The majority of studies revealed that PDE5i have a potentially positive effect on maintaining EF, mainly in the shortterm after pelvic RT. Despite penile prostheses' high efficacy, their role remains limited due to various factors. Regarding yoga, a randomised clinical trial demonstrated clinical effectiveness only during the first 4 weeks of the twice/week regimen of sessions.

Treatment strategies for RIED range from oral medication to more invasive treatment modalities that present high efficacy. Penile prosthesis remains the most invasive, yet the most effective and definitive treatment. Stem cell therapy, platelet-rich plasma intracavernosal injections, and penile vibratory stimulation feature an efficient profile, but their beneficial role has not yet been established. Further randomized controlled trials are required to assess the effectiveness of these interventions.

Establishing strategies for the needs of survivors with RIED should also be prioritized in the therapeutic management, because patients' quality of life can be substantially improved.