Sexual Function After Laser Therapy for Penile Cancer: A Systematic Review.

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.