Localization of neurovascular bundles on pelvic CT and evaluation of radiation dose to structures putatively involved in erectile dysfunction after prostate brachytherapy
Abstract
PURPOSE: To (a) locate neurovascular bundles (NVB) on pelvic CT and (b) retrospectively evaluate relationships between radiation dose to structures putatively involved in prostate brachytherapy-induced erectile dysfunction (ED) and incidence of postbrachytherapy ED.
METHODS AND MATERIALS: (a) Right/left NVB were identified on nine prostate MRIs. Structures visible on MRI and CT were cross-referenced. Cross-sectional area of each NVB was measured. (b) All patients treated with implant alone and whose treatment was planned on Variseed (Varian Medical Systems, Palo Alto, CA), with follow-up of >12 months were included; n = 41. Median follow-up was 20 months. All patients were potent (+/- sildenafil) before implant (erection sufficient for intercourse). The right/left NVB (using results from part "a"), penile bulb, and right/left crus were outlined on postimplant CT. Volumes and doses to these structures were calculated.
RESULTS: (a) On prostate MRI, NVB was consistently located where the prostate border bends away from the levator ani, at the gland's smallest radius of curvature. Average area of the circle best encompassing the NVB = 0.27 cm(2); diameter was 0.58 cm. (b) 11 of 41 (27%) patients had ED; 30 of 41 were potent (15 with sildenafil). There was no significant difference between potent/impotent patients in isotope, age, diabetes, hypertension, follow-up, or volume of prostate, bulb, right/left NVB, or right/left crus. There was a relationship between smoking and ED (p…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 41 participants or records.
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