title: The concept of erectile function preservation (penile rehabilitation) in the patient after brachytherapy for prostate cancer.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, Beth Israel Medical Center, New York, NY, USA.
authors.forename: Doron S
authors.initials: DS
authors.lastname: Stember
authors.forename: John P
authors.initials: JP
authors.lastname: Mulhall
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D007172:Erectile Dysfunction / Q000503:physiopathology / Q000517:prevention & control* / Q000534:rehabilitation; D006801:Humans; D008297:Male; D010410:Penile Erection / Q000502:physiology / Q000528:radiation effects*; D010413:Penis / Q000502:physiology / Q000528:radiation effects*; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries; D011879:Radiotherapy Dosage