Introduction: Penile cancer is rare but rising in incidence. Any optimal treatment must balance oncologic control with preservation of sexual and urinary function. Objectives: To evaluate sexual function, patient satisfaction, and oncologic outcomes after carbon dioxide (CO2), neodymium-doped yttrium aluminum garnet (Nd:YAG), and thulium-doped yttrium aluminum garnet (Tm:YAG) laser therapies for penile cancer. Methods: A systematic review was conducted in accordance with PRISMA 2020. We searched PubMed, Embase, Scopus, Google Scholar, ScienceDirect, ClinicalTrials.gov, and conference proceedings from January 2000 to 5 February 2025 for observational studies reporting sexual function after laser therapy. Risk of bias was assessed with the Newcastle–Ottawa Scale (NOS) and certainty of evidence with Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: Eleven studies comprising 593 patients were included, mostly carcinoma in situ or T1. Local recurrence occurred in 6–19% of patients with Tis/T1 and 17–42% in ≥T2. Across laser types, 59–72% of patients retained erectile function, 50–100% reported sexual satisfaction, and 80–100% reported satisfaction with the cosmetic outcomes, with some degree of variation. Reports on libido and orgasm were heterogeneous and generally unvalidated. General patient satisfaction was high but often assessed using non-validated instruments. Conclusions: Laser therapy is a reasonable penile-sparing option for Tis/T1 disease, but mandates strict surveillance. Data are insufficient to support its use for ≥T2 tumors. Laser therapy generally preserves sexual function, but heterogeneous and non-standardized reporting limits firm conclusions. Prospective studies with standardized patient-reported outcome measures are needed.
引言：阴茎癌虽属罕见，但发病率呈上升趋势。任何理想治疗方案均需在肿瘤控制与保留性功能及排尿功能之间取得平衡。目的：评估二氧化碳（CO₂）激光、掺钕钇铝石榴石（Nd:YAG）激光及掺铥钇铝石榴石（Tm:YAG）激光治疗阴茎癌后的性功能、患者满意度及肿瘤学结局。方法：按照PRISMA 2020指南进行系统综述。检索2000年1月至2025年2月5日期间PubMed、Embase、Scopus、Google Scholar、ScienceDirect、ClinicalTrials.gov及会议论文集中报告激光治疗后性功能的观察性研究。采用纽卡斯尔-渥太华量表（NOS）评估偏倚风险，使用推荐分级的评估、制定与评价（GRADE）系统评估证据质量。结果：共纳入11项研究，涉及593例患者，主要为原位癌或T1期肿瘤。Tis/T1期患者局部复发率为6–19%，≥T2期患者为17–42%。各类激光治疗后，59–72%患者保留勃起功能，50–100%患者报告性满意度，80–100%患者对美容效果表示满意，但存在一定差异。关于性欲和性高潮的报告异质性高且多未经验证。总体患者满意度较高，但常使用非标准化工具评估。结论：激光治疗是Tis/T1期疾病合理的保留阴茎治疗方案，但需严格随访监测。现有数据不足以支持其用于≥T2期肿瘤。激光治疗总体上能保留性功能，但异质性及非标准化的报告方式限制了明确结论的得出。未来需采用标准化的患者报告结局指标开展前瞻性研究。
Sexual Function After Laser Therapy for Penile Cancer: A Systematic Review
肿瘤(癌症)患者之家