Contemporary Management of Post-Prostatectomy Climacturia: A Review

Abstract

Climacturia is estimated to effect approximately 30% of men after radical prostatectomy and has significant impact on patient quality of life. In this narrative review, our aim is to describe the pathophysiology of climacturia, its predictive factors, and the existing conservative and surgical treatment options in the modern era. Peer-reviewed publications on the post-prostatectomy climacturia were identified through a PubMed search, with terms included climacturia, arousal incontinence, post prostatectomy incontinence, orgasm and radical prostatectomy. While the pathophysiology of climacturia remains poorly understood and predictive factors poorly elucidated, men experiencing climacturia often report significant bother and reduction in quality of life. Various treatment options have been investigated for this condition, with conservative measures including pelvic floor physical therapy and variable penile tension loops, and operative strategies including the Mini-Jupette and traditional bladder slings. As providers of comprehensive urologic care for prostate cancer survivors, it is incumbent upon urologists to query patients about bothersome climacturia and offer these evidence-based treatment options.