Incontinence associated with orgasm or sexual activity is a common problem in men who have undergone radical prostatectomy and has a detrimental effect on quality of life, according to two recent studies.

In their paper published in the Journal of Sexual Medicine, researchers from Karolinska Institutet, Stockholm, Sweden, used a study-specific questionnaire to follow-up over 1,400 men who had undergone radical prostatectomy at Karolinska Hospital between 2002 and 2006. 1,288 men responded to the questionnaire, 691 of whom reported that they were sexually active. 61% of the sexually active men had never experienced orgasm-associated urinary incontinence, 28% experienced climacturia less than half the time, 7% more than half the time and 4% reported urine leakage at every orgasm. 14% of men who reported orgasm-associated incontinence were also daytime incontinent of urine, but the remaining 86% of these men were otherwise fully continent. Furthermore, climacturia was more common in men who also reported a loss of penile length after surgery and in men who also reported postoperative erectile dysfunction. Orgasm-related incontinence was associated with a significant decrease in quality of life compared to men who did not experience the symptom, with those who suffered from climacturia reporting less frequent intercourse, poorer satisfaction from orgasm and avoidance of sex for fear of failing. 68% of men who had experienced an episode of climacturia in the previous 6 months described their quality of life as low or moderate, compared with only 46% of those who did not leak urine at orgasm.

These results were mirrored in a separate study, carried out at the New York University Langone Medical Center. Researchers gathered information from 1,459 men who had undergone radical prostatectomy by a single surgeon between 2000 and 2007. Patients completed a questionnaire at 3, 6, 12 and 24 months after surgery, and the group analyzed the frequency of incontinence during sexual activity at each time point, and with respect to daytime stress urinary incontinence. Over 44% of patients reported that they were bothered by incontinence during sexual activity at 3 months after surgery. However, this proportion had decreased to 22% at 24 months. Sexual-activity-associated incontinence was strongly associated with stress urinary incontinence at all time points, but some men who did not experience stress incontinence were affected by incontinence during sexual activity, with 10% of otherwise continent men reporting the symptom. Overall, the association between stress urinary incontinence and sexual-activity-associated incontinence led the researchers to conclude that it is likely that the mechanisms underlying these two symptoms are similar.

These studies will raise awareness of a common complication of radical prostatectomy that is often ignored in favor of focusing on the arguably more severe complications of erectile dysfunction and overt urinary incontinence. Although the treatment options for climacturia are severely lacking, this symptom causes considerable distress to patients with an adverse effect on quality of life and should not be overlooked by urologists.