Prevalence and Predicting Factors for Commonly Neglected Sexual Side Effects to Radical Prostatectomies: Results from a Cross-Sectional Questionnaire-Based Study

Abstract

Introduction Altered perception of orgasm, orgasm-associated pain, penile sensory changes, urinary incontinence (UI) during sexual activity, penile shortening (PS), and penile deformity following radical prostatectomy (RP) have received increasing attention from researchers. Aim The aim of this study is to describe the prevalence and predictors of the above-mentioned side effects. Methods This was a cross-sectional questionnaire-based study among men who had undergone RP between 3 and 36 months prior to study inclusion. Predicting factors were identified through logistic regression analyses. Main Outcome Measures The primary outcome measures were prevalence rates of the above-mentioned side effects. Results Overall, 316 questionnaires were available for analyses. Of the sexually active patients (n = 256), 12 (5%) reported anorgasmia, whereas 153 (60%) reported decreased orgasm intensity. Delayed orgasms were reported by 146 (57%). Twenty-three patients (10%) had experienced pain during orgasm. UI during sexual activity were reported by 99 patients (38%). Out of the whole population, 77 patients (25%) reported sensory changes in the penis. A total of 143 patients (47%) reported a subjective loss of penile length of >1 cm. An altered curvature of the penis was reported by 30 patients (10%). Patients had increasing risk of UI during sexual activity (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.10–1.25) and orgasmic dysfunction (OR 1.09; 95% CI 1.01–1.16) with increasing International Consultation on Incontinence Questionnaire scores. Erectile dysfunction (OR 1.81; 95% CI 1.07–3.10) and a high body mass index (OR 1.10; 95% CI 1.02–1.19) increased the risk of PS after RP. Nerve-sparing (OR 0.32; 95% CI 0.16–0.95) reduced the risk of PS. Conclusions Orgasm-associated problems, UI during sexual activity, penile sensory changes, PS, and penile deformity are common side effects to RP. Daytime UI, erectile dysfunction, and nerve-sparing status can help identify patients at risk.

Orgasmic Dysfunction after Radical Prostatectomy

“…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.…”

“…More recently, Frey et al [30] reported a similar rate of 38% of patients complaining of UI associated with sexual activity in a series of 256 patients following RP; moreover, these authors asked patients to objectively quantify how much this issue negatively impacted their sexual activity, and reported a median “bother” score of 3 out of 10, which still seems surprisingly low. Conversely, in other series, climacturia was found to severely impact various aspects of sexual life, including low partner satisfaction, fear of intercourse failure, and low satisfaction with orgasm [28].…”

Oversizing Penile Prosthesis Length as per the Erect Length by Intra-Cavernosal Injection of Vasoactive Material

“…In patients with peripheral neuropathy, sizing should be even more conservative. Further dissatisfaction is noted in patients with a risk factor for shortening such as those with Peyronie's disease [5] , post-radical prostatectomy [6] , post-neglected priapism [7] , and in patients with a concealed penis.…”

Development of booklet on male sexual dysfunction, its measures and assessing its impact on knowledge of patients with urological cancers

“…[345] Organ associated problems, urinary incontinence during sexual activity, penile sensory changes, penile shrinkage, and penile deformity are common side effects experienced by patient who had undergone radical prostatectomy and testicular cancer. [46]…”