Climacturia: a Comprehensive Review Assessing Pathophysiology, Prevalence, Impact, and Treatment Options Regarding the "leak of Pleasure"

Overview

Journal Int J Impot Res

Specialties Reproductive Medicine
Urology

Date 2020 Mar 24

PMID 32203427

Citations 6

Authors

Ioannis Mykoniatis

Koenraad van Renterghem

Ioannis Sokolakis

Georgios Hatzichristodoulou

Maxime Sempels

Robert Andrianne

Affiliations

Soon will be listed here.

Abstract

Aim of this review is to summarize and evaluate the current literature on the pathophysiology, prevalence, sociosexual impact, and potential treatment options of climacturia. Climacturia, defined as orgasm-associated urinary incontinence and characterized by great prevalence variability, ranging between 15.7 and 93% was, so far, a relatively neglected post-radical prostatectomy functional side-effect. Recent studies have shown that it can significantly impact the quality of life of couples after prostate cancer treatment. A knowledge gap characterizes the pathophysiologic pathways while treatment is based on empirically chosen treatment options (condom use, presexual intercourse urination) or on therapeutic modalities proposed by low-quality studies (pelvic floor muscle training, penile applied devices). Evidence regarding efficacy of surgical techniques (artificial urinary sphincter, male sling, or dual implantation of penile prosthesis with a sling) for climacturia treatment are limited but with an increasing trend of relevant published data in the last 5 years. The mini-jupette sling plus inflatable penile prosthesis placement is a promising surgical technique that has been studied in a multi-institutional cohort with encouraging results regarding climacturia, erectile dysfunction, and mild-incontinence control. However, future studies with longer follow-up and larger sample sizes are certainly needed to confirm the long-term safety and benefits of this intervention.

Citing Articles

Shorter prostatic urethral length in preoperative Magnetic Resonance Imaging is associated with higher risk of climacturia following robot-assisted laparoscopic radical prostatectomy.

Munoz-Calahorro C, Parada-Blazquez M, Garcia-Sanchez C, Lopez-Arellano L, Parra Lopez M, Lozano-Blasco J Int J Impot Res. 2024; .

PMID: 39256624 DOI: 10.1038/s41443-024-00974-8.

Report of climacturia and orgasmic disorders after radical prostatectomy in a Brazilian tertiary hospital: shedding light on a neglected condition.

Gamberini P, Nascimento B, Filho H, Nahas W, de Bessa Junior J, Teixeira T Int Urol Nephrol. 2024; 57(1):115-120.

PMID: 39153132 DOI: 10.1007/s11255-024-04181-8.

The 'Mini-Jupette' technique for climacturia: a systematic review.

Ioannis M, Stavros T, Eliophotos S, Georgios L, Anastasios A, van Renterghem K Ther Adv Urol. 2023; 15:17562872231215180.

PMID: 38090352 PMC: 10714878. DOI: 10.1177/17562872231215180.

Sexual function and rehabilitation after radiation therapy for prostate cancer: a review.

Nguyen D, Berlin A, Matthew A, Perlis N, Elterman D Int J Impot Res. 2021; 33(4):410-417.

PMID: 33408347 DOI: 10.1038/s41443-020-00389-1.

Dual implantation of penile prosthesis and ATOMS system for post-prostatectomy erectile dysfunction and urinary incontinence: a feasibility study.

Falcone M, Preto M, Ammirati E, Blecher G, Carone R, Gontero P Int J Impot Res. 2020; 33(6):577-582.

PMID: 32499613 DOI: 10.1038/s41443-020-0320-y.

References

Ficarra V, Novara G, Ahlering T, Costello A, Eastham J, Graefen M . Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol. 2012; 62(3):418-30. DOI: 10.1016/j.eururo.2012.05.046. View

Ficarra V, Novara G, Rosen R, Artibani W, Carroll P, Costello A . Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol. 2012; 62(3):405-17. DOI: 10.1016/j.eururo.2012.05.045. View

Salonia A, Adaikan G, Buvat J, Carrier S, El-Meliegy A, Hatzimouratidis K . Sexual Rehabilitation After Treatment For Prostate Cancer-Part 2: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med. 2017; 14(3):297-315. DOI: 10.1016/j.jsxm.2016.11.324. View

Salonia A, Burnett A, Graefen M, Hatzimouratidis K, Montorsi F, Mulhall J . Prevention and management of postprostatectomy sexual dysfunctions. Part 1: choosing the right patient at the right time for the right surgery. Eur Urol. 2012; 62(2):261-72. DOI: 10.1016/j.eururo.2012.04.046. View

Clavell-Hernandez J, Martin C, Wang R . Orgasmic Dysfunction Following Radical Prostatectomy: Review of Current Literature. Sex Med Rev. 2017; 6(1):124-134. DOI: 10.1016/j.sxmr.2017.09.003. View

Mitchell S, Jain R, Laze J, Lepor H . Post-prostatectomy incontinence during sexual activity: a single center prevalence study. J Urol. 2011; 186(3):982-5. DOI: 10.1016/j.juro.2011.04.088. View

Alwaal A, Breyer B, Lue T . Normal male sexual function: emphasis on orgasm and ejaculation. Fertil Steril. 2015; 104(5):1051-60. PMC: 4896089. DOI: 10.1016/j.fertnstert.2015.08.033. View

DeLancey J . Anatomy and physiology of urinary continence. Clin Obstet Gynecol. 1990; 33(2):298-307. DOI: 10.1097/00003081-199006000-00014. View

Koeman M, van Driel M, Schultz W, Mensink H . Orgasm after radical prostatectomy. Br J Urol. 1996; 77(6):861-4. DOI: 10.1046/j.1464-410x.1996.01416.x. View

10.

Groutz A, Blaivas J, Chaikin D, Weiss J, Verhaaren M . The pathophysiology of post-radical prostatectomy incontinence: a clinical and video urodynamic study. J Urol. 2000; 163(6):1767-70. View

11.

Choi J, Nelson C, Stasi J, Mulhall J . Orgasm associated incontinence (climacturia) following radical pelvic surgery: rates of occurrence and predictors. J Urol. 2007; 177(6):2223-6. DOI: 10.1016/j.juro.2007.01.150. View

12.

ONeil B, Presson A, Gannon J, Stephenson R, Lowrance W, Dechet C . Climacturia after definitive treatment of prostate cancer. J Urol. 2013; 191(1):159-63. DOI: 10.1016/j.juro.2013.06.122. View

13.

Tetzschner T, Sorensen M, Jonsson L, Lose G, Christiansen J . Delivery and pudendal nerve function. Acta Obstet Gynecol Scand. 1997; 76(4):324-31. DOI: 10.1111/j.1600-0412.1997.tb07986.x. View

14.

Possover M, Forman A . Voiding Dysfunction Associated with Pudendal Nerve Entrapment. Curr Bladder Dysfunct Rep. 2012; 7(4):281-285. PMC: 3497942. DOI: 10.1007/s11884-012-0156-5. View

15.

Manassero F, Di Paola G, Paperini D, Mogorovich A, Pistolesi D, Valent F . Orgasm-associated incontinence (climacturia) after bladder neck-sparing radical prostatectomy: clinical and video-urodynamic evaluation. J Sex Med. 2012; 9(8):2150-6. DOI: 10.1111/j.1743-6109.2012.02829.x. View

16.

Nilsson A, Carlsson S, Johansson E, Jonsson M, Adding C, Nyberg T . Orgasm-associated urinary incontinence and sexual life after radical prostatectomy. J Sex Med. 2011; 8(9):2632-9. DOI: 10.1111/j.1743-6109.2011.02347.x. View

17.

Mendez M, Sexton S, Lentz A . Contemporary Review of Male and Female Climacturia and Urinary Leakage During Sexual Activities. Sex Med Rev. 2017; 6(1):16-28. DOI: 10.1016/j.sxmr.2017.07.012. View

18.

Lee J, Hersey K, Lee C, Fleshner N . Climacturia following radical prostatectomy: prevalence and risk factors. J Urol. 2006; 176(6 Pt 1):2562-5. DOI: 10.1016/j.juro.2006.07.158. View

19.

Barnas J, Pierpaoli S, Ladd P, Valenzuela R, Aviv N, Parker M . The prevalence and nature of orgasmic dysfunction after radical prostatectomy. BJU Int. 2004; 94(4):603-5. DOI: 10.1111/j.1464-410X.2004.05009.x. View

20.

Messaoudi R, Menard J, Ripert T, Parquet H, Staerman F . Erectile dysfunction and sexual health after radical prostatectomy: impact of sexual motivation. Int J Impot Res. 2011; 23(2):81-6. DOI: 10.1038/ijir.2011.8. View