title: Orgasm-associated incontinence (climacturia) after bladder neck-sparing radical prostatectomy: clinical and video-urodynamic evaluation.
abstract: BACKGROUND
  Orgasm-Associated Incontinence (OAI) or climacturia has been observed in male patients maintaining sexual potency after radical prostatectomy and cystectomy.
  
  
  OBJECTIVE
  We investigated the incidence and video-urodynamic aspects of this event in continent and potent patients after bladder neck-sparing (BNS) radical prostatectomy (RP).
  
  
  METHODS
  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.
authors: Department of Urology, University of Pisa, Pisa, Italy. francy_manassero@hotmail.com
authors: Francesca
authors: F
authors: Manassero
authors: Giuseppe
authors: G
authors: Di Paola
authors: Davide
authors: D
authors: Paperini
authors: Andrea
authors: A
authors: Mogorovich
authors: Donatella
authors: D
authors: Pistolesi
authors: Francesca
authors: F
authors: Valent
authors: Cesare
authors: C
authors: Selli
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009948:Orgasm; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011795:Surveys and Questionnaires; D014521:Urethra / Q000601:surgery; D001743:Urinary Bladder / Q000503:physiopathology / Q000601:surgery; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D014563:Urodynamics; D014743:Videotape Recording