Bother Associated with Climacturia After Radical Prostatectomy: Prevalence and Predictors

Abstract

Introduction Orgasm-associated incontinence, climacturia, is one of the lesser studied radical prostatectomy (RP) complications. Little is known about patient bother related to this condition, specifically, its prevalence and predictors. Aim To ascertain the prevalence and predictors of patient bother associated with climacturia. Methods Patients presenting for the evaluation of sexual dysfunction after RP at a single center were queried on various domains of sexual dysfunction. This included orgasmic dysfunction and sexual incontinence (including climacturia and arousal incontinence). Patients were specifically asked about the frequency and amount of climacturia. In addition, questions addressed patient bother and the perceived bother of their partners. Descriptive statistics were used for patient characteristics. A t-test was used for comparing the frequency of patient and partner bother, and the Pearson correlation test compared relationships between bother and predictors. Multivariable analysis was conducted to define predictors of climacturia-associated bother. Main Outcome Measure The main outcome measures was the prevalence and predictors of climacturia-associated patient bother and perceived partner bother. Results Climacturia was reported by 23% of 3,207 consecutive men analyzed. Bother of any degree was experienced by 45% of these patients, and 14% reported partner bother related to this condition. Patient bother was associated with perceived partner bother (P < .001) and inversely correlated with relationship duration (P < .001). The overall frequency and quantity of climacturia were also predictive (P < .001 for both). In the adjusted model, all of these factors remained significant. Clinical Implications Given the prevalence of this condition and the bother associated with it, this complication should be discussed with patients preoperatively. Strength & Limitations Strengths include a large study population and specific questions on climacturia-associated bother. Limitations include the fact that it is a single-center study and no direct partner questioning occurred. Conclusion Climacturia and its associated bother are common after RP. The predictors of patient bother include perceived partner bother, shorter relationship duration, and increasing frequency and quantity of climacturia.

Contemporary Management of Post-Prostatectomy Climacturia: A Review

“…Furthermore, Capogrosso found 31% of climacturic men to experience climacturia greater than half of their total of orgasms, while 94% to experience the symptoms in greater than 50% of orgasms [15]. Similarly, Salter found approximately 25% of effected men to experience climacturia in greater than half of orgasms, with approximately 75% having the symptom in less than half [16].…”

“…The estimated prevalence of climacturia following RP has ranged greatly since its first description. Notably, most studies have included sample sizes of less than 300 patients and relied on variable non-validated questionnaires [6][7][8][9][10][11][12][13][14][15][16]. For example, Barnas et al [7] found the rate of climacturia could be reported as high as 93% if defined as at least one episode following RP.…”

“…For example, Barnas et al [7] found the rate of climacturia could be reported as high as 93% if defined as at least one episode following RP. In the two largest pub-lished reports, Mitchell et al [12] prospectively examined 1459 patients from a single surgeon and Salter et al [16] retrospectively reviewed 3207 men presenting at a single sexual medicine clinic. Rates of climacturia over a series of months were reported as 36% and 23%, respectively.…”

“…Existing studies have shown post-RP climacturia to vary in both in clinical severity and rate of bother, with most men experiencing frequent but low volume orgasmic urinary loss [18]. Salter quantified volume of climacturia into small (drops), moderate (<30 mL), or large (>30 mL), finding respective frequencies of 70%, 24%, and 6% [16]. This distribution is similar to other reports, with Lee and Capogrosso reporting 58% and 84% of patients having only drops or less than 5 mL or leakage, respectively [8,15].…”

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).…”