Bother associated with climacturia after radical prostatectomy: prevalence, degree and predictors
Bach, P1; Miranda, EP1; Jenkins, L1; Nelson, C1; Mulhall, J1
1: MSKCC, USA
Objective: While ED and incontinence are well-understood complications of radical prostatectomy (RP), climacturia remains under-appreciated despite its prevalence in this population. Clinical experience suggests that many men and partners are bothered by this RP sequela. Our objective was to characterize and define predictors of climacturia-associated bother in men after RP.
Methods: The study was a retrospective review of all men presenting to a single center for management of sexual dysfunction following RP. Patients were queried on various domains of sexual dysfunction including ED, orgasmic and ejaculatory dysfunction, sexual incontinence, and penile deformity. Patients were specifically asked to quantify the amount and frequency of climacturia and to report their level of bother and to quantify the degree of partner bother. Predictors of bother were determined using multivariable analysis (MVA).
Results: 252 patients post-RP were included. Mean patient and partner ages were 60±8 years and 55±9 years, respectively. 81% of patients were white and 82% of patients were in stable relationships with a mean duration of 24±14 years. 59% of patients reported at least one occurrence of climacturia. Significantly more men reported bother related to climacturia than partner bother related to OAI (39% vs 13%, respectively; RR=2.95, 95% CI: 2.29-3.80, p<0.01). Patient and reported partner bother were related (r=0.31, p<0.001). Both patient and partner bother were negatively related to length of relationship (r=-0.14, p=0.05; r=-0.18, p=0.02). In MVA predicting patient bother, only perceived partner bother remained significant (OR=4.49, 95% CI: 1.64-12.27, p<0.01). In MVA predicting reported partner bother, both patient bother (OR=4.49, 95% CI: 1.64-12.27, p<0.01) and duration of relationship (OR=0.96, 95% CI: 0.92-1.00, p=0.05) were significant predictors.
Conclusions: Climacturia is highly prevalent (59% of men) and bothersome in men and their partners following RP. While patient and partner bother from climacturia are related and more commonly seen in shorter relationships, patients are more bothered by climacturia than are their partners. Physicians treating patients with RP should both counsel patients about climacturia pre-operatively and specifically inquire about climacturia post-operatively.
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