title: Orgasm associated incontinence (climacturia) following radical pelvic surgery: rates of occurrence and predictors.
abstract: OBJECTIVE
  Orgasm associated incontinence, that is the inadvertent leakage of urine at orgasm, has received little attention in the literature. We evaluated the rate of occurrence of orgasm associated incontinence following radical pelvic surgery as well as its associated factors and predictors.
  
  
  METHODS
  From January 2005 to March 2006, 696 patients were evaluated for post-radical pelvic surgery sexual dysfunction. A database was created, and descriptive statistics, chi-square analysis and logistic regression analysis were used to evaluate associated factors and predictors.
  
  
  RESULTS
  Of 475 patients 96 (20%) reported orgasm associated incontinence following radical pelvic surgery. The incidence was significantly less in the cystoprostatectomy group than in the open and laparoscopic radical prostatectomy groups (p <0.05). Orgasm associated incontinence was more commonly found within 12 months following surgery vs greater than 12 months (RR 0.81, 95% CI 0.72-0.92, p <0.01) and in patients with orgasm associated pain (RR 1.09, 95% CI 1.01-1.16, p <0.01) and penile length loss (RR 1.32, 95% CI 1.09-1.59, p <0.01). On multivariate analysis all factors associated on univariate analyses remained predictive. Orgasm associated incontinence was not associated with patient age, the degree of nerve sparing, surgical margin status, seminal vesicle or lymph node involvement, preoperative erectile function, nocturnal erections, libido level or daytime continence.
  
  
  CONCLUSIONS
  Orgasm associated incontinence occurs in a fifth of men (96 of 475) following radical pelvic surgery. The incidence of orgasm associated incontinence is greater with radical prostatectomy than with radical cystectomy and it is unrelated to the type of prostatectomy performed (open vs laparoscopic). Orgasm associated incontinence is more likely to be reported within year 1 following surgery and in men who complain of orgasmic pain and/or penile shortening.
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021, USA.
authors.forename: Judy M
authors.initials: JM
authors.lastname: Choi
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Nelson
authors.forename: Jason
authors.initials: J
authors.lastname: Stasi
authors.forename: John P
authors.initials: JP
authors.lastname: Mulhall
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D015653:Cystectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009948:Orgasm; D011468:Prostatectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014549:Urinary Incontinence / Q000453:epidemiology*