Incidence of climacturia “surprising” to one leading surgeon


It is sometimes amazing how little some physicians appear to understand about the side effects of the treatments that they give to their patients! If these were really rare side effects it might be understandable, but the one we shall discuss below is far from rare …

A few weeks ago we commented on an article from a Swedish research group about the incidence of climacturia (the involuntary release of urine during intercourse) by men after a radical prostatectomy. (This of course assumes that we are talking about men who are actually still capable of intercourse after radical prostate surgery.) Nilsson et al. had estimated that just under 40 percent of their series of patients who were sexually active suffered from climacturia. An earlier paper, by Lee et al., published in 2006, had reported that about half of their patients had this problem.

Now a new paper by Mitchell et al. in the Journal of Urology states that the incidence of “any bother” from incontinence during sexual activity was 44.4 percent at 3 months post-surgery and 36.1 percent at 24 months post-surgery in the authors’ series of 1,459 patients treated between 2000 and 2007.

What is astonishing about this paper is not the result. It is what the senior, highly regarded surgeon who carried out those 1,457 operations is quoted as saying in the Reuters report on this paper. Apparently, ‘he and his colleagues were “a bit surprised” by how common sexual incontinence was in their study.’ Specifically he went on to state that:

I think it’s something that those of us who perform radical prostatectomy should be aware of in terms of counseling our patients, and also in terms of finding ways to treat this if it ends up being a problem.

Well duuuh … to coin a phrase!

Did this gentleman never read the paper by Lee et al. from 2006? We are talking about someone who is a full professor of urology at a major teaching institution, and who has specialized in research into and the treatment of disorders of the prostate for years. The paper by Lee and his colleagues was hardly an obscure paper in an obscure journal! And its not as though incontinence during sexual activity is exactly some “new” complication of radical prostatectomy. Many patients have been faced with this as a relatively common side effect over the past 20 years (even though the term “climacturia” was indeed coined by Lee et al. in their 2006 paper). Has the surgeon in question actually been listening to his patients at all when they talk about their post-surgical complications?

The “New” Prostate Cancer InfoLink is tempted to wonder whether we need to compile a list of the relatively common side effects of radical prostatectomy to hand out not to patients … but to at least some members of the urology community!

16 Responses

  1. Not astonishing for me!!

    I ran a MiniPoll on the Yana site a little while back to see how many men were told about what are sometimes referred to as “minor” side effects — climacturia, Peyronie’s and loss of size.

    The results of the poll (which has no scientific value, of course) can be found here if anyone is interested. As you will see, 76% of the respondents said they had not been told anything about these three potential problems. Hence the fact that I am neither astonished nor surprised.

  2. Hey Terry, good to “see” your voice here. And heartfelt thanks for your years of fierce dedication to YANA!

    Another subtlety connected with the syndrome above is that a kind of orgasmic response to physical stimulation is possible in men who cannot achieve erection, and involuntary (and sometimes voluminous) expression of urine is quite often part of this response. Not the kind of thing you’re going to hear from your surgeon — if you hear anything at all about sexual function or urinary continence. You’re more likely to hear about incontinence, maybe some vague warning that this is likely to “change your sexual life”, but both together? I doubt it.

  3. ” … whether we need to compile a list of the relatively common side effects of radical prostatectomy …”

    That may be a good idea, BUT, why only RP? Why not all treatments, including active surveillance?

  4. What are the side effects of active surveillance other than occasional angst generally caused by people telling them they are nuts for not having a definitive therapy, i.e., radical prostatectomy, radiation, etc.?

  5. Dear Robert:

    That would depend upon the nature and speed of progression of the individual cancer. Under the “best case” scenario, there might be no side effects of active surveillance at all in a man with truly indolent disease that was growing so slowly that it never became clinically significant. In the “worst case” scenario, where the disease was actually much more aggressive than anyone realized based on the initial diagnostic biopsy, a man might suddenly discover that instead of a low-risk, Gleason 6 cancer entirely confined to the prostate, he actually had a high-risk Gleason 8 cancer that had already micrometastasized despite every good reason for initial thinking that the cancer could have been monitored safely. (This is just one reason why many centers believe that a second biopsy is a good idea before placing men on an active surveillance protocol. It is likely to minimize this risk.)

    However, if we consider the most common situation — a man with relatively slowly growing, low-risk, Gleason 6 cancer in only one or two biopsy cores — the most common potential side effect while on active surveillance would be the potential for gradual increase in urinary “bother” (e.g., increased frequeny of urination, reduced stream, difficulties with stopping and starting urination, etc.) as a consequence of pressure on the urethra and urethral sphincters caused by growth of the tumor over time. We are not aware of precise data on the incidence of such side effects in the currently published literature, so we cannot give you a precise probability of such side effects. Also, a great deal would depend on things like the age and the urinary tract status of the patient at the time of initiation of active surveillance, the time on active surveillance, and the precise placement of cancerous tissue in the individual’s prostate.

  6. There does not seem to be any treatment for this problem. I guess we just have live with it

  7. This spring I reported my climacturia to my oncologist, because I was recently widowed and am somewhat apprehensive of starting a brand new relationship with fairly severe climacturia. He acted totally surprised that I had such a problem and when I asked for literature he said he did not know of any. It was not until I read press reports about the Mitchell paper in the Journal of Urology that I realized the “Well … duuuh” response as appropriate. A brief alert in a journal like JAMA would seem more than appropriate to me.

  8. After nerve-sparing RP 12 months ago, an extra problem for me is “erotic-thought climacturia” (so described by my surgeon) — there is tiny leakage when these thoughts occur!

    Whereas once upon a time I would obtain an erection, now I get leakage.

    “Richard” wrote about this in a Phoenix 5 article (in 2000) but which I downloaded in November 2011. His complete story is virtually mine in every respect.

    I would be interested to read of others’ experiences regarding this phenomenon.

  9. Julian:

    You do have company … and while I don’t wish it on anyone, its nice to know I’m not alone.

    I had a nerve-sparing robot-assisted RP 3.5 years ago and it’s taken me this long to find others who experience this problem — especially the “erotic thought climacturia”, or a squirt if I see an attractive woman or even catch a wiff of her perfume. I did my exercises prior to and after my surgery and nothing has worked to diminish or eliminate the problem. Neither my surgeon or urologist seemed to be aware of this issue (or won’t admit to it). I do have a great deal of resentment when I think of being told my orgasms would be “dry” or that I would have to wear a pad for the rest of my life because of my evil thoughts. By the way, I don’t have stress or urge incontinence. I don’t think I would have changed my mind about having the surgery, but I would have appreciated going into it with my eyes open about all the possible outcomes.

    I’m sure it won’t help but you’re not alone or crazy.

    Good luck.

  10. I have “erotic thought climacturia” after a holmium laser prostate procedure for BPH. I also have daytime incontinence, mainly when standing, 5 months after the surgery.

  11. Even though the last comment was a year ago I’m glad I found this page. Like others here, I thought I was alone in experiencing climacturia and the related “erotic-thought climacturia”. My urologist-surgeon is a sensitive caring kind of guy, yet he has never told me this is a fairly common response.

    (By the way it took some careful refining of my Google search before I found this page. Many of my searches brought up sites for people who choose to pee for erotic pleasure — which is fine if that’s what you enjoy but it wasn’t quite what I was looking for!)

  12. I tried a condom during sex and blew it off during ejaculation. I’ve had no improvement in the past year. Sex is great, but no bladder control.

    Gordon

  13. Its been 2 years since anyone has posted but here it goes: I had my prostate removed spring of 07. For approx. 7 years I had dry orgasms which, on a scale of 1-10, rated a 1.

    Then 7 years after my operation I started to experience climacturia (although I didn’t know what it was for 18 months) and it hasn’t stopped, nor would I want it to. On a scale of 1-10, it is a 10!

    Is this unusual? Safe? Why after 7 years? Will it end? If it’s safe, I hope it never ends. At no time since my operation, had I ever experienced incontinence except when I currently have orgasms. I am currently 62.

    Chuck

  14. Dear Chuck:

    As one get’s goes through life, to quote a wise man, “Sh** happens!”

    No one can answer the “Why?” “Why me?” “Why now?” questions related to issues like this. It may have something to do with certain musculature becoming weaker under high stress as you get older. But frankly, if it is “good for you”, who cares? Make the most of it while it lasts!

    :O)

  15. I began masturbating reasonably soon after my robotic surgery 7 years ago and over time the quality and frequency of my orgasms have changed.

    I can remember thinking after the first few orgasms that this sensation was very different from and not nearly as satisfying as my pre-op experience. Now, 7 years later, I can bring my mostly soft penis to orgasm and much of the pre-op physical and mental “delight” has returned. …

    At the same time, I now experience significant climaturia. I ejaculate so much urine that I must hold my free hand over my penis to block the flow! (I have discovered that emptying my bladder before orgasm reduces the amount of urine in climaturia.) lthough the climaturia initially came as a surprise, I must admit that it is somewhat satisfying. It is reminiscent of a pre-op orgasm.

  16. When I reported this problem to my radiation oncologist after it emerged he said he had not heard of it before!

    The first time I heard it acknowledged was by Dr. Mulhall at a conference over 3 years ago.

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