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Climacturia (Uroclimax) in Men After Radical Prostatectomy: A Comprehensive Review of the Current Literature and Treatment Strategies

  • Male Sexual Dysfunction and Disorders (A Pastuszak and N Thirumavalavan, Section Editors)
  • Published:
  • volume 11pages 381–388 (2019)
Current Sexual Health Reports Aims and scope Submit manuscript

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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.

Recent Findings

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.

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Robot-assistant laparoscopic prostatectomy


Prostate cancer


Radical prostatectomy;


External beam radiation therapy


Pelvic floor physical therapy


Stress urinary incontinence


Artificial urethral sphincter


Inflatable penile prosthesis


Male urethral mini-sling


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Koeman M, van Driel MF, Schultz WC, Mensink HJ. Orgasm after radical prostatectomy. Br J Urol. 1996;77(6):861–4.

    Article  CAS  PubMed  Google Scholar 

  2. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. Jama. 1999;281(6):537–44.

    Article  CAS  PubMed  Google Scholar 

  3. Flynn KE, Lin L, Bruner DW, Cyranowski JM, Hahn EA, Jeffery DD, et al. Sexual satisfaction and the importance of sexual health to quality of life throughout the life course of U.S. adults. J Sex Med. 2016;13(11):1642–50.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Flynn KE, Reese JB, Jeffery DD, Abernethy AP, Lin L, Shelby RA, et al. Patient experiences with communication about sex during and after treatment for cancer. Psychooncology. 2012;21(6):594–601.

    Article  PubMed  Google Scholar 

  5. Manassero F, Di Paola G, Paperini D, Mogorovich A, Pistolesi D, Valent F, et al. Orgasm-associated incontinence (climacturia) after bladder neck-sparing radical prostatectomy: clinical and video-urodynamic evaluation. J Sex Med. 2012;9(8):2150–6.

    Article  PubMed  Google Scholar 

  6. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49(6):822–30.

    Article  CAS  PubMed  Google Scholar 

  7. Lee J, Hersey K, Lee CT, Fleshner N. Climacturia following radical prostatectomy: prevalence and risk factors. J Urol. 2006;176(6 Pt 1):2562–5 discussion 2565.

    Article  PubMed  Google Scholar 

  8. Fode M, Serefoglu EC, Albersen M, Sønksen J. Sexuality following radical prostatectomy: is restoration of erectile function enough? Sexual Medicine Reviews. 2017;5(1):110–9.

    Article  PubMed  Google Scholar 

  9. Nilsson AE, Carlsson S, Johansson E, Jonsson MN, Adding C, Nyberg T, et al. Orgasm-associated urinary incontinence and sexual life after radical prostatectomy. J Sex Med. 2011;8(9):2632–9.

    Article  PubMed  Google Scholar 

  10. Martinez-Salamanca Garcia JI, Jara Rascon J, Moncada Iribarren I, Garcia Burgos J, Hernandez Fernandez C. Orgasm and its impact on quality of life after radical prostatectomy. Actas Urol Esp. 2004;28(10):756–60.

    Article  CAS  PubMed  Google Scholar 

  11. Barnas JL, Pierpaoli S, Ladd P, Valenzuela R, Aviv N, Parker M, et al. The prevalence and nature of orgasmic dysfunction after radical prostatectomy. BJU Int. 2004;94(4):603–5.

    Article  PubMed  Google Scholar 

  12. Pearcy R. The prevalence and nature of orgasmic dysfunction after radical prostatectomy. BJU Int. 2005;95(3):452–3 author reply 453.

    Article  PubMed  Google Scholar 

  13. Abouassaly R, Lane BR, Lakin MM, Klein EA, Gill IS. Ejaculatory urine incontinence after radical prostatectomy. Urology. 2006;68(6):1248–52.

    Article  PubMed  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Choi JM, Nelson CJ, Stasi J, Mulhall JP. Orgasm associated incontinence (climacturia) following radical pelvic surgery: rates of occurrence and predictors. J Urol. 2007;177(6):2223–6.

    Article  PubMed  Google Scholar 

  16. Loizaga Iriarte A, Paz Diaz-Romeral JL, Arciniega Garcia JM, Arceo Santiago R, Perez Fernandez A, Unda Urzaiz M. Climacturia, a symptom to take into account after radical prostatectomy. Actas Urol Esp. 2007;31(4):345–8.

    Article  CAS  PubMed  Google Scholar 

  17. El-Khatib FM, Towe M, Choi J, Yafi FA. Management of climacturia during inflatable penile prosthesis surgery. Curr Urol Rep. 2019;20(4):16.

    Article  PubMed  Google Scholar 

  18. •• Mitchell SA, Jain RK, Laze J, Lepor H. Post-prostatectomy incontinence during sexual activity: a single center prevalence study. J Urol. 2011;186(3):982–5 One of the few high level studies perfomed on patients with uroclimax after radical prostatectomy.

    Article  PubMed  Google Scholar 

  19. Mehta A, Deveci S, Mulhall JP. Efficacy of a penile variable tension loop for improving climacturia after radical prostatectomy. BJU Int. 2013;111(3):500–4.

    Article  PubMed  Google Scholar 

  20. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7–30.

    Article  PubMed  Google Scholar 

  21. Tyson MD 2nd, Andrews PE, Ferrigni RF, Humphreys MR, Parker AS, Castle EP. Radical Prostatectomy Trends in the United States: 1998 to 2011. Mayo Clin Proc. 2016;91(1):10–6.

    Article  PubMed  Google Scholar 

  22. Herlemann A, Cowan JE, Carroll PR, Cooperberg MR. Community-based outcomes of open versus robot-assisted radical prostatectomy. Eur Urol. 2018;73(2):215–23.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  24. Capogrosso P, Ventimiglia E, Serino A, Stabile A, Boeri L, Gandaglia G, et al. Orgasmic dysfunction after robot-assisted versus open radical prostatectomy. Eur Urol. 2016;70(2):223–6.

    Article  PubMed  Google Scholar 

  25. Frey A, Sonksen J, Jakobsen H, Fode M. Prevalence and predicting factors for commonly neglected sexual side effects to radical prostatectomies: results from a cross-sectional questionnaire-based study. J Sex Med. 2014;11(9):2318–26.

    Article  PubMed  Google Scholar 

  26. O’Neil BB, Presson A, Gannon J, Stephenson RA, Lowrance W, Dechet CB, et al. Climacturia after definitive treatment of prostate cancer. J Urol. 2014;191(1):159–63.

    Article  PubMed  Google Scholar 

  27. Gerstenberg TC, Levin RJ, Wagner G. Erection and ejaculation in man. Assessment of the electromyographic activity of the bulbocavernosus and ischiocavernosus muscles. Br J Urol. 1990;65(4):395–402.

    Article  CAS  PubMed  Google Scholar 

  28. Cruz Y, Juárez R, Medel A, Corona-Quintanilla DL, Pacheco P, Juárez M. Coital urinary incontinence induced by impairment of the dorsal nerve of the clitoris in rats. J Urol. 2016;195(2):507–14.

    Article  PubMed  Google Scholar 

  29. Clavell-Hernandez J, Martin C, Wang R. Orgasmic dysfunction following radical prostatectomy: review of current literature. Sex Med Rev. 2018;6(1):124–34.

    Article  PubMed  Google Scholar 

  30. Jain R, Mitchell S, Laze J, Lepor H. The effect of surgical intervention for stress urinary incontinence (UI) on post-prostatectomy UI during sexual activity. BJU Int. 2012;109(8):1208–12.

    Article  CAS  PubMed  Google Scholar 

  31. Sighinolfi MC, Rivalta M, Mofferdin A, Micali S, De Stefani S, Bianchi G. Potential effectiveness of pelvic floor rehabilitation treatment for postradical prostatectomy incontinence, climacturia, and erectile dysfunction: a case series. J Sex Med. 2009;6(12):3496–9.

    Article  PubMed  Google Scholar 

  32. Geraerts I, Van Poppel H, Devoogdt N, De Groef A, Fieuws S, Van Kampen M. Pelvic floor muscle training for erectile dysfunction and climacturia 1 year after nerve sparing radical prostatectomy: a randomized controlled trial. Int J Impot Res. 2015;28:9.

    Article  PubMed  Google Scholar 

  33. Chung ASJ, Suarez OA, McCammon KA. AdVance male sling. Translational Andrology and Urology. 2017;6(4):674–81.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Comiter CV, Dobberfuhl AD. The artificial urinary sphincter and male sling for postprostatectomy incontinence: which patient should get which procedure? Investig Clin Urol. 2016;57(1):3–13.

    Article  PubMed  PubMed Central  Google 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 

  37. Mancini JG, Kizer WS, Jones LA, Mora RV, Morey AF. Patient satisfaction after dual implantation of inflatable penile and artificial urinary sphincter prostheses. Urology. 2008;71(5):893–6.

    Article  PubMed  Google Scholar 

  38. Mendez M, Sexton S, Lentz A. 008 Transcorporal artificial urinary sphincter placement in patients with prior inflatable penile prosthesis utilizing 6-ply acellular graft: a novel technique with resolution of climacturia. J Sex Med. 2017;14(2, Supplement):e4.

    Article  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.

    Article  PubMed  Google 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.

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Correspondence to Aram Loeb.

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Mishra, K., Jain, N., Bukavina, L. et al. Climacturia (Uroclimax) in Men After Radical Prostatectomy: A Comprehensive Review of the Current Literature and Treatment Strategies. Curr Sex Health Rep 11, 381–388 (2019).

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