Climacturia (Uroclimax) in Men After Radical Prostatectomy: A Comprehensive Review of the Current Literature and Treatment Strategies
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Purpose of Review
Climacturia is an underreported condition seen in men who undergo radical prostatectomy. An estimated 16–93% of these patients may suffer from climacturia, with significant adverse effect on their sexual satisfaction and quality of life. Our understanding of the pathology is limited, with no standard treatment algorithm. In this review, we aim to contextualize the condition in relation to the current literature and offer an in depth evaluation of the treatment strategies, with a focus on the surgical interventions.
There has been an increased emphasis on evaluating patients for climacturia routinely after radical prostatectomy. Due to the increased identification of climacturia, the last two decades have seen the development of novel techniques to address the condition. Behavioral therapy is the initial intervention that should be tried; however, depending on other comorbidities, the patient can be offered surgical interventions. These include artificial urinary sphincter, male sling, or dual implantation of penile prosthesis with an artificial sphincter or a sling.
In this review, we provide a comprehensive review of the etiology, pathophysiology, and treatment strategies related to climacturia. This review focuses on current literature on the topic, with an emphasis on the available surgical interventions.
KeywordsClimacturia Men’s health Sexual dysfunction Sexual medicine
Robot-assistant laparoscopic prostatectomy
External beam radiation therapy
Pelvic floor physical therapy
Stress urinary incontinence
Artificial urethral sphincter
Inflatable penile prosthesis
Male urethral mini-sling
Compliance With Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Research Involving Human Participants and/or Animals
This article does not contain any studies with human or animal subjects performed by the author.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 23.• Sooriakumaran P, Pini G, Nyberg T, Derogar M, Carlsson S, Stranne J, et al. Erectile function and oncologic outcomes following open retropubic and robot-assisted radical prostatectomy: results from the laparoscopic prostatectomy robot open trial. Eur Urol. 2018;73(4):618–27 A review of the incidence of postprostatectomy sexual dysfunction, with an emphasis on the need for postoperative evaluation and coulseling for sexual dysfucntion. CrossRefGoogle Scholar
- 35.Urkmez A, Ozsoy E, Tokuc E, Kutluhan MA, Topaktas R, Artuk I, et al. Effect of artificial urinary sphincter implantation on erectile function and sexual satisfaction. Andrologia. 2019;0(0):e13295.Google Scholar
- 36.•• Christine B, Bella AJ. MP48-04 climacturia: an under-addressed sequela of radical prostatectomy, but treatment is only a sling away. J Urol. 2016;195(4, Supplement):e636 One of the largest series reported on uroclimax with a subsequent surgical intervention.Google Scholar
- 39.•• Yafi FA, Andrianne R, Alzweri L, Brady J, Butcher M, Chevalier D, et al. Andrianne Mini-Jupette graft at the time of inflatable penile prosthesis placement for the management of post-prostatectomy climacturia and minimal urinary incontinence. J Sex Med. 2018;15(5):789–96 One of the largest series looking at postoperative ooutcomes after Mini-Jupette sling for patietns with uroclimax.CrossRefGoogle Scholar
- 40.•• Valenzuela RJ, Ziegelmann MJ, Hillelsohn JH, Farrell MR, Kent MA, Levine LA. Preliminary outcomes of the male urethral “mini-sling”: a modified approach to the Andrianne Mini-Jupette procedure with penile prosthesis placement for climacturia and mild stress urinary incontinence. J Sex Med. 2019; A study higlighting the efficacy of various novel surgical strategies used in uroclimax and their efficacy on symptomatic relief for this patient population. Google Scholar