Defining factors predictive of persistent climacturia after radical prostatectomy

Abstract

ABSTRACT Introduction Climacturia (Cl) is defined as the involuntary leakage of urine around the time of orgasm. Cl is a common clinical condition after radical prostatectomy (RP). Cl is a barrier to sexual satisfaction. Rates as high as 60% have been reported with little data on the chronology of recovery. Objective This study aimed to evaluate the natural history of CI after RP. Methods Men who underwent RP and completed a proprietary sexual incontinence questionnaire at 12 and 24 months (±3 months) constituted the study sample. Pre or postop ADT or radiation therapy were exclusions. We assessed demographics, comorbidities, baseline testosterone (T), pre-RP prostate specific antigen (PSA), Gleason group, nerve sparing status (NSS), and the presence of stress urinary incontinence (SUI) post-RP. Primary end-point was Cl rate at 12 and 24 months post-RP. Predictors of Cl were analyzed using a series of logistic regression models. Factors entered into the model included age, diabetes, smoking history, baseline T, baseline PSA, Gleason score sum, and NSS score. Results Data on 152 men were analyzed. Mean age 61±8 years. 45% had hypertension, 60% hyperlipidemia, 10% had diabetes, 18% obstructive sleep apnea, 8% were current smoker, and 27% former smokers. Baseline T and PSA were 421±176 ng/dL and 7±6 ng/mL. The median Gleason score was 7, 82% of patients had bilateral NSS, 13% unilateral. Median NSS score was 3 (IQR 2, 4). Cl prevalence at 12 and 24 months post-surgery were 38% and 39%. No patient characteristics were associated with CI at either 12 or 24 months post-RP. Conclusion Cl is highly prevalent at 12 months post RP and when present at this juncture appears to be unlikely to recover. Disclosure Work supported by industry: no.