Prevalence and Predictors of Climacturia and Associated Patient/Partner Bother in Patients with History of Definitive Therapy for Prostate Cancer

Abstract

Background Climacturia is an under-reported complication of definitive therapy for prostate cancer (PCa) - that is, radical prostatectomy (RP) and/or radiation therapy (RT). Aim We sought to identify the prevalence and predictors of climacturia and associated patient/partner bother in patients with and without prior PCa treatment. Methods We analyzed a database of patients who presented to our Men's Health clinic and filled out a questionnaire related to sexual function and pertinent medical histories. The prevalence of climacturia and associated patient/partner bother in patients with/without prior RP/RT was calculated. Univariable and multivariable logistic regressions were performed to identify predictors associated with climacturia and patient/partner bother. Outcomes The primary outcomes were the prevalence and predictors of climacturia and associated patient/partner bother in patients with/without history of definitive PCa treatment. Results Among 1,117 patients able to achieve orgasm, 192 patients (17%) had prior history of definitive therapy for PCa (RP alone = 139 [72%]; RT alone = 22 [11%]; RP + RT = 31 [16%]). Climacturia was reported by 39%, 14%, 52%, and 2.4% of patients with history of RP alone, RT alone, RP + RT, and neither RP nor RT, respectively (P < .05 between all groups). 33 to 45 percent of patients with climacturia noted significant patient/partner bother. Factors significantly associated with climacturia were prior RP, prior RT, history of other prostate surgery, and erectile dysfunction, although erectile dysfunction was not significant on multivariable analysis. Significant reduction in climacturia prevalence was noted for patients who were ≥1 year out from RP, compared with patients who were <1 year out. Among patients with prior RP/RT, stress urinary incontinence was associated with increased risk of climacturia, whereas diabetes was associated with decreased risk. No factors were associated with patient/partner bother. Among patients with prior RP, nerve-sparing technique did not predict presence of climacturia but was associated with reduced patient/partner bother. Clinical translation Given significant prevalence of climacturia and associated patient/partner bother, patients should be counseled on the risk of climacturia before undergoing RP/RT. Strengths and limitations Strengths include the large study population and the focus on both RP and RT. Limitations include the facts that this is a single-institution study that primarily relies on patients’ subjective reporting and that the study population may not represent the general population. Conclusions Climacturia affects a significant proportion of patients with history of RP/RT for PCa, and many patients and their partners find this bothersome.

Contemporary Management of Post-Prostatectomy Climacturia: A Review

“…Patient perception of partner bother is consistently noted to be a major source of distress among those experiencing climacturia. Salter and colleagues found this metric to have the greatest odds of predicting patient bother on multivariate analysis [8,16,19]. Furthermore, two studies examining both heterosexual and homosexual men found shorter relationship duration was associated with increased patient bother due to climacturia [16,22].…”

“…Climacturia can cause significant negative psychosexual effects, with approximately half of patients reporting some level of bother due to the symptoms. Affected patients report lower sexual satisfaction, as well as higher rates of depression and anxiety [6,10,12,16,19]. In comparison, a 3year follow-up of the landmark CEASAR trial found stress urinary incontinence (SUI) to cause bother in only 19% of affected men, despite this symptom being a more recognized and counseled effect of RP [20,21].…”

“…Interviewees in short-term relationships reported distress to arise from concern that climacturia would lead to rejection by potential new partners, in contrast to those in long-term relationships [23]. Notably, the literature remains mixed on the effect of volume and frequency of climacturia on patient bother, with Jimbo finding no association, but Salter finding both metrics to be significant [16,19].…”

“…Corresponding with this theory is the observation that climacturia tends to improve with time from surgery, potentially allowing for improved coaptation of the bladder neck as operative trauma resolves [15]. It has been observed that prior transurethral resection of the prostate (TURP) increases risk of climacturia, possibly due to bladder neck alteration which is further exacerbated by RP [10,19]. However, this initial theory may not completely explain the pathophysiology of climacturia, as complete lack of a continence mech-anism during orgasm would logically cause all RP patients to experience passage of urine with every orgasm.…”

Narrative review of male urethral sling for post-prostatectomy stress incontinence: sling type, patient selection, and clinical applications

“…Climacturia is a bothersome condition in which patients report incontinence with orgasm. While previously underreported, it is now thought to be prevalent in 23% to 40% of men post radical prostatectomy (83,84). A retrospective review by Nolan et al found that in men with general stress incontinence plus climacturia, AdVance slings improved both subjective frequency of climacturia as well as associated bother (85).…”