Climacturia after Definitive Treatment of Prostate Cancer

Abstract

Climacturia is experienced by a substantial proportion of men after undergoing definitive treatment of prostate cancer. We found a complex relationship between stress urinary incontinence and climacturia, and noted that the presence of climacturia does not necessarily negatively impact sexual satisfaction.

Orgasmic Dysfunction after Radical Prostatectomy

“…Interestingly, recovery rates of 10% and 30% from PO were observed at 12 and 60 months after surgery, respectively, thus corroborating previous findings that demonstrated a decrease in the frequency and intensity of pain throughout the follow-up [33]. Although UI and EF impairment have been previously associated with orgasmic modifications after surgery [25293035], no data have suggested strong predictors for PO occurrence after RP; however, a significantly higher prevalence of PO after ORP than after RARP has been reported (9.5% vs. 11.6%; p=0.04) [31]. Similarly, in a series of 156 RARP cases, Tewari et al [34] reported that only 3.2% of patients complained of PO after treatment.…”

“…Indeed, in an assessment of the potential predictors of climacturia, Frey et al [30] showed a higher risk of climacturia in patients with postoperative UI, and similar findings were observed by O'Neil et al [29] in patients treated with surgery or radiation therapy. Conversely, Nilsson et al [28] explored orgasm-associated incontinence in a consecutive series of 691 sexually active RP patients, of whom 268 reported climacturia despite recovering full UC in 86% of cases.…”

“…UI has been previously associated with the occurrence of climacturia after surgery [282930]. Indeed, in an assessment of the potential predictors of climacturia, Frey et al [30] showed a higher risk of climacturia in patients with postoperative UI, and similar findings were observed by O'Neil et al [29] in patients treated with surgery or radiation therapy.…”

“…The exact prevalence of climacturia in patients who undergo RP is unknown, given the huge variability in reported rates, ranging between 20% and 93% (Table 1) [232425262728293031]. In 1996, Koeman et al [24] first assessed orgasmic problems in a small series of patients treated with RP and reported that 9 out of 14 patients experienced involuntary loss of urine at orgasm.…”

“…In a prospective survey including 42 patients, climacturia was reported in 45% of cases, with 58% of them complaining of losing only a few drops of urine, while 16% reported a loss of more than 1 ounce [25]. Interestingly, O'Neil et al [29] assessed sexually related side effects in a series of 412 patients treated with surgery and/or radiation therapy for PCa; these authors showed an overall rate of climacturia as high as 22.6% after treatment, with rates of 28.3%, 5.2%, and 28.6% after surgery, radiation, or both, respectively.…”