Climacturia: a comprehensive review assessing pathophysiology, prevalence, impact, and treatment options regarding the “leak of pleasure”

Mykoniatis, Ioannis; Renterghem, Koenraad van; Sokolakis, Ioannis; Hatzichristodoulou, Georgios; Sempels, Maxime; Andrianne, Robert

doi:10.1038/s41443-020-0257-1

Cited by 7 publications

(8 citation statements)

References 46 publications

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“…Salter found 62% of men to report mild bother, 29% moderate, and 9% severe, while Mitchell found 55.6% to report "No Problem", 22% a "Minor Problem", and 22.4% a "Major Problem" [12,16]. These studies suggest that while climacturia may not cause major bother in most of those affected, symptoms can be immensely impactful for a subset of men [18]. Indeed, one report found 36% of patients reporting avoidance of intercourse altogether as a result [10].…”

Section: Prevalence and Clinical Significancementioning

confidence: 89%

“…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].…”

Section: Prevalence and Clinical Significancementioning

confidence: 99%

“…Multiple authors have suggested that climacturia represents a form of stress urinary incontinence (SUI) in which increased intraabdominal pressure during orgasm causes leakage of urine [18]. Indeed, direct damage to the external urinary sphincter and injury to the prostatic nerve plexus during RP are thought to cause post-operative SUI due to sphincter insufficiency [25][26][27].…”

Section: Proposed Mechanisms Of Climacturiamentioning

confidence: 99%

“…Surgical management of climacturia was first investigated by Robert Andrienne in 2006 with the invention of the Mini-Jupette sling [18,45]. This technique involves concurrent placement of a mesh graft between the bilateral corporal cylinders during inflatable penile prosthetic (IPP) insertion [46].…”

Section: Mini-jupette Slingmentioning

confidence: 99%

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Contemporary Management of Post-Prostatectomy Climacturia: A Review

Chestnut¹,

Hehemann²

2022

JOMH

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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.

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Section: Prevalence and Clinical Significancementioning

confidence: 89%

Section: Prevalence and Clinical Significancementioning

confidence: 99%

Section: Proposed Mechanisms Of Climacturiamentioning

confidence: 99%

Section: Mini-jupette Slingmentioning

confidence: 99%

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Contemporary Management of Post-Prostatectomy Climacturia: A Review

Chestnut¹,

Hehemann²

2022

JOMH

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“…2,3 Treatment options for ED vary from phosphodiesterase-5 inhibitors to penile prosthesis implantation. 4,5 Although not as frequent, orgasm-associated incontinence, also known as climacturia, is a side effect of RP that leads to sexual dysfunction. Climacturia, classified as orgasmic dysfunction, involves involuntary urine leakage during ejaculation or sexual arousal.…”

Section: Introductionmentioning

confidence: 99%

The ‘Mini-Jupette’ technique for climacturia: a systematic review

Ioannis,

Stavros,

Eliophotos

et al. 2023

Therapeutic Advances in Urology

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Background: The leakage of urine during sexual arousal, known as climacturia, is an under-recognized clinical condition often overshadowed by erectile dysfunction in men who have undergone radical prostatectomy. Objectives: This study aims to determine and evaluate the role of the Mini-Jupette technique and its alternatives in the treatment of climacturia. Data sources and methods: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. We searched Medline via PubMed, Scopus, and the Cochrane Library databases until October 2022. Results: We included seven studies involving 120 patients with climacturia. Different types of grafts were used, ranging from synthetic mesh to autologous grafts. In all seven studies, the use of the Adrianne Mini-Jupette (AMJ) and its alternatives showed a high percentage of improvement in climacturia, with reported complete resolution ranging from 65% to 93%. Regarding postoperative complications, one study reported the highest sling explantation rate at 11% (4/38), while other studies reported complications ranging from subjective symptoms such as dysuria and perineal pain to the need for subsequent artificial urinary sphincter placement. Conclusion: The AMJ sling and its variations are low-cost, time-efficient, and relatively safe procedures with high patient satisfaction rates among those treated for climacturia.

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