Orgasm-Associated Incontinence (Climacturia) after Bladder Neck-Sparing Radical Prostatectomy: Clinical and Video-Urodynamic Evaluation

Introduction. Orgasm-Associated Incontinence (OAI) or climacturia has been observed in male patients maintaining sexual potency after radical prostatectomy and cystectomy. Aim. We investigated the incidence and video-urodynamic aspects of this event in continent and potent patients after bladder neck-sparing (BNS) radical prostatectomy (RP). Main Outcome Measure. Comparing functional and morphological aspects between climacturic and non-climacturic patients to identify a possible explanation of this unusual kind of leakage that could seriously impact the sexual life after surgery. Methods. In a pool of 84 men, potent and continent at least 1 year after BNS RP, 24 (28.6%) reported climacturia and 7 agreed to undergo video-urodynamic evaluation (group 1), which was performed also in 5 controls (group 2). Those 12 men were also evaluated with 24-hour pad test, 5-item International Index of Erectile Function and International Prostate Symptom Score questionnaires. Results. Functional urethral length (FUL) was significantly lower in the climacturia group (P = 0.02) and time to continence recovery was significantly longer (P = 0.05). No other significant differences were found between the two groups. The radiological appearance of the vesicourethral junction at voiding cystourethrography was similar. Conclusions. To the best of our knowledge, this is the first functional and morphological evaluation of climacturia after RP. In our experience, this event is indirectly associated with a reduced FUL in the sphincter area, although both patients and controls were continent during daily activities. BNS technique seems to reduce time to continence recovery, although climacturic patients need longer time than control patients. Since in our series no rigidity of the vesicourethral anastomosis was radiographically evident, we believe that differences in FUL could explain OAI. Anatomical difference in membranous urethra length could explain the occurrence of this symptom in patients treated with the same surgical technique. Manassero F, Di Paola G, Paperini D, Mogorovich A, Pistolesi D, Valent F, and Selli C. Orgasm-associated incontinence (climacturia) after bladder neck-sparing radical prostatectomy: Clinical and video-urodynamic evaluation. J Sex Med 2012;9:21502156.