Climacturia as a side effect of radical prostatectomy

“Climacturia” is the involuntary release of urine at the time of orgasm during sexual activity. A new paper by a Swedish research team has expanded our understanding of the prevalence of this problem among men after surgery for localized prostate cancer.

Some years ago, Lee et al. reported that climacturia occurred in about half of a small series of their patients at about 2 years after radical prostatectomy. Now, Nilsson et al. have provided data from a series of 1,411 men who received radical prostatectomies at Karolinska University Hospital, Stockholm, Sweden, between 2002 and 2006. They have also attempted to provide some degree of insight into the impact of climacturia on sexual satisfaction.

The patients were all treated by open or by robot-assisted laparoscopic surgery and were asked to complete a study-specific questionnaire, with the following rimray results:

  • 1,288/1,411 eligible men (91.3 percent) completed the questionnaire.
  • 691/1,288 men providing information (53.6 percent) were sexually active.
  • 268/691 sexually active men (37.6 percent) reported climacturia.
  • 230/268 sexually active men reporting climacturia (85.8 percent) were otherwise completely continent.

When data from the 268 sexually active men reporting climacturia are compared to the data from the 422 sexually active men who did not report climacturia, the authors found the following additional results:

  • A prevalance ratio of 1.5 (range, 1.2 to 1.8) for not being able to satisfy the partner
  • A prevalence ratio of 2.1 (range, 1.1 to 3.5) for avoidance of sexual activity because of fear of failure
  • A prevalence ratio of 1.5 (range, 1.1 to 2.1) for low orgasmic satisfaction
  • A prevalence ratio of 1.4 (range, 1.2 to 1.7) for having sexual intercourse infrequently.
  • These prevalence ratios increase in prostate-cancer survivors with a higher frequency of climacturia.

What this study does not, unfortunately, seem to tell us is what percentage of the 600 patients in this study who are no longer sexually active stopped having sexual activity because of climacturia.

It is important to understand that the amount of urine expelled at orgasm by men with climacturia is very variable (from a few drops, which are almost unnoticeable to a significant stream).

It is possible to avoid some of the less pleasant aspects of climacturia by amptyiong the bladder prior to sexual activity or by use of a condom. However, it is also clear that climacturia can be distressing to partners of men who suffer from this condition, and the risk for climacturia is another side effect of radical prostatectomy that — unfortunately — is all too often not addressed by surgeons in explaining the risks associated with radical prostatectomy.

One Response

  1. There is a new treatment available called Urostop — a small loop placed at base of penis. Gives just a little tension enough to stop urine leak but is not noticed but it does not need to be pulled too tight.

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