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Management of Climacturia During Inflatable Penile Prosthesis Surgery

  • Surgery (J Simhan, Section Editor)
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Abstract

Radical prostatectomy, the preferred treatment option for organ-confined prostate cancer, is associated with a wide variety of sexual dysfunctions including erectile and orgasmic dysfunctions. Climacturia is a type of orgasmic dysfunction that has been reported to occur in 20–60% of men after radical prostatectomy. Several treatment strategies for climacturia have been evaluated and recommended including behavioral changes, use of special devices, medications, specialized therapies, and surgeries. Inflatable penile prosthesis implantation might be the treatment of choice when conservative management approaches fail to treat erectile dysfunction. In this review article, the different options and approaches for the management of climacturia during inflatable penile prosthesis surgery will be discussed.

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References

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  1. Benson CR, Serefoglu EC, Hellstrom WJG. Sexual dysfunction following radical prostatectomy. J Androl. 2013;33:1143–54. https://doi.org/10.2164/jandrol.112.016790.

    Article  CAS  Google Scholar 

  2. Shpot EV, Chinenov DV, Amosov AV, Chernov YN, Yurova MV, Lerner YV. Erectile dysfunction associated with radical prostatectomy: appropriateness and methods to preserve potency. Urologiia. 2018;2:75–82.

    Article  Google Scholar 

  3. Frey A, Sønksen 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;11:2318–26. https://doi.org/10.1111/jsm.12624.

    Article  PubMed  Google Scholar 

  4. . Christine B, Bella AJ. Climacturia: an under-addressed sequela of radical prostatectomy, but treatment is only a sling away. J Urol. 2016;195:e636 Abstract presented at the 2016 Annual fall scientific meeting of the Sexual Medicine Society. One of the largest studies to date on surgical outcomes for climacturia.

    Google Scholar 

  5. Fode M, Serefoglu EC, Albersen M, Sønksen J. Sexuality following radical prostatectomy: is restoration of erectile function enough? Sex Med Rev. 2017;5:110–9. https://doi.org/10.1016/j.sxmr.2016.07.005.

    Article  PubMed  Google Scholar 

  6. 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;94:603–5. https://doi.org/10.1111/j.1464-410X.2004.05009.x.

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  8. . Mendez MH, Sexton SJ, Lentz AC. Contemporary review of male and female climacturia and urinary leakage during sexual activities. Sex Med Rev. 2018;6:16–28. https://doi.org/10.1016/j.sxmr.2017.07.012 A large literature review through Pubmed from 1996 To 2017 regarding urinary leakage during sexual activities for men including foreplay, coital incontinence and climacturia. Treatment options were reported.

    Article  PubMed  Google Scholar 

  9. Dadhich P, Hockenberry M, Kirby EW, Lipshultz L. Penile prosthesis in the management of erectile dysfunction following cancer therapy. Transl Androl Urol. 2017;6:S883–9. https://doi.org/10.21037/tau.2017.07.05.

    Article  PubMed  PubMed Central  Google Scholar 

  10. DeLancey JO. Anatomy and physiology of urinary continence. Clin Obstet Gynecol. 1990;33:298–307.

    Article  CAS  Google Scholar 

  11. Mulhall JP. Men’s sexual health and fertility. New York: Springer; 2014.

    Book  Google Scholar 

  12. 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;191:159–63. https://doi.org/10.1016/j.juro.2013.06.122.

    Article  PubMed  Google Scholar 

  13. . 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;70:223–6. https://doi.org/10.1016/j.eururo.2015.10.046 Large number of patients recruited (1023) from a single tertiary referral center between 2003 and 2013.

    Article  PubMed  Google Scholar 

  14. Lee J, Hersey K, Lee CT, Fleshner N. Climacturia following radical prostatectomy: prevalence and risk factors. J Urol. 2006;176:2562–5.

    Article  Google Scholar 

  15. Mehta A, Deveci S, Mulhall JP. Efficacy of a penile variable tension loop for improving climacturia after radical prostatectomy. BJU Int. 2013;111:500–4. https://doi.org/10.1111/j.1464-410X.2012.11269.x.

    Article  PubMed  Google Scholar 

  16. Moore KC, Lucas MG. Management of male urinary incontinence. Indian J Urol. 2010;26:236–44. https://doi.org/10.4103/0970-1591.65398.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 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. 2016;28:9–13. https://doi.org/10.1038/ijir.2015.24.

    Article  CAS  PubMed  Google Scholar 

  18. Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27:1361–7.

    Article  Google Scholar 

  19. Rolle L, Ceruti C, Sedigh O, Timpano M, Destefanis P, Lillaz B, et al. Surgical implantation of artificial urinary device and penile prosthesis through trans-scrotal incision for postprostatectomy urinary incontinence and erectile dysfunction: synchronous or delayed procedure? Urology. 2012;80:1046–50. https://doi.org/10.1016/j.urology.2012.08.003.

    Article  PubMed  Google Scholar 

  20. Rhee EY. Technique for concomitant implantation of the penile prosthesis with the male sling. J Urol. 2005;173:925–7.

    Article  CAS  Google Scholar 

  21. Gorbatiy V, et al. Outcomes of simultaneous placement of an inflatable penile prosthesis and a male urethral sling through a single perineal incision. Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, Feb. 2010, www.ncbi.nlm.nih.gov/pubmed/19796057/.

  22. Lee D, Romero C, Alba F, Westney OL, Wang R. Simultaneous penile prosthesis and male sling/artificial urinary sphincter. Asian J Androl. 2013;15:10–5. https://doi.org/10.1038/aja.2012.115.

    Article  PubMed  Google Scholar 

  23. Comiter CV, Dobberfuhl AD. The artificial urinary sphincter and male sling for postprostatectomy incontinence: which patient should get which procedure? Investig Clin Urol. 2016;57:3–13. https://doi.org/10.4111/icu.2016.57.1.3.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Christine B, Knoll LD. Simultaneous advance male sling and an inflatable penile prosthesis: concurrent placement does not increase potential for implant infection. J Urol. 2011;185:e726.

    Google Scholar 

  25. Lai HH, Hsu EI, Teh BS, Butler EB, Boone TB. 13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine. J Urol. 2007;177:1021–5.

    Article  Google Scholar 

  26. 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;71:893–6. https://doi.org/10.1016/j.urology.2007.10.018.

    Article  PubMed  Google Scholar 

  27. . Mendez MS, Sexton S, Lentz A. Transcorporal artificial urinary sphincter placement in patients with prior inflatable penile prosthesis utilizing 6-ply acellular graft: a novel technique with resolution of climacturia [abstract]. J Sex Med. 2017;14:e4. https://doi.org/10.1016/j.jsxm.2016.12.021 It presents a novel technique of transcorporal artificial urinary sphincter (AUS) placement utilizing a 6-ply acellular graft as a barrier between the AUS and IPP components with attention to the resultant urinary and sexual function outcomes.

    Article  Google Scholar 

  28. . 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;15:789–96. https://doi.org/10.1016/j.jsxm.2018.01.015 A pilot multicenter study of patients with post-RP erectile dysfunction and climacturia undergoing IPP insertion with concomitant placement of a Mini-Jupette graft. Strengths of this study include the novel nature of this intervention, the multi- institutional nature of the study, and the promising results demonstrated.

    Article  PubMed  Google Scholar 

  29. Bauer RM, Grabbert MT, Klehr B, Gebhartl P, Gozzi C, Homberg R, et al. 36-month data for the AdVance XP® male sling: results of a prospective multicentre study. BJU Int. 2017;119:626–30. https://doi.org/10.1111/bju.13704.

    Article  PubMed  Google Scholar 

  30. Kent M, Say R, Bornick E, Cavallo J, Valenzuela R. Inflatable penile prosthesis and ‘mini male urethral sling’ placement for the treatment of erectile dysfunction and climacturia. J Urol. 2018;199:e421. https://doi.org/10.1016/j.juro.2018.02.1055.

    Article  Google Scholar 

  31. 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;9:2150–6. https://doi.org/10.1111/j.1743-6109.2012.02829.x.

    Article  PubMed  Google Scholar 

  32. NIH Stem Cell Information Home Page. In Stem Cell Information [World Wide Web site]. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services, 2016 [cited October 30, 2018] Available at <//stemcells.nih.gov/info/basics/1.htm>.

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Correspondence to Faysal A. Yafi.

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Farouk M. El-Khatib, Maxwell Towe, Judy Choi, and Faysal A. Yafi each declare no potential conflicts of interest.

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El-Khatib, F.M., Towe, M., Choi, J. et al. Management of Climacturia During Inflatable Penile Prosthesis Surgery. Curr Urol Rep 20, 16 (2019). https://doi.org/10.1007/s11934-019-0879-3

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  • DOI: https://doi.org/10.1007/s11934-019-0879-3

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