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Shorter prostatic urethral length in preoperative Magnetic Resonance Imaging is associated with higher risk of climacturia following robot-assisted laparoscopic radical prostatectomy

International Journal of Impotence Research (2024)Cite this article

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Abstract

Climacturia is defined as the leakage of urine during orgasm and it is an adverse effect of radical prostatectomy. Our goal was to determine if various preoperative MRI pelvic floor measurements were associated with the risk of climacturia following robot-assisted laparoscopic radical prostatectomy. For this purpose, we conducted a prospective study involving 57 patients who underwent robot-assisted laparoscopic radical prostatectomy. MRI measurements were analysed by 2 urologists and 2 radiologists. Follow-up was carried out at 3, 6, and 12 months using the Parra orgasmic function questionnaire. We analysed all measurements, along with other patient, surgery, and tumour characteristics, classifying patients into two groups based on the presence or absence of climacturia. A logistic regression model was applied among statistically significant variables. STROBE recommendations were taken into consideration. Shorter prostatic urethral length was associated with higher risk of climacturia at 3 months, OR = 0.83 (95%CI 0.688–0.98) (p = 0.024). Patients with climacturia at 6 months had greater median urethral width [12.66 mm, interquartile range (IQR): 11.77–13.55 vs 12.13 mm, IQR 11.08–13.18] (p = 0.02). Patients with climacturia at 12 months had a higher proportion of preoperative lower urinary tract symptoms (57.14% vs. 20%) (p = 0.026). In the logistic regression, the history of lower urinary tract symptoms was associated with a higher risk of climacturia, OR = 6.07 (95% CI 1.342-26.03) (p = 0.023). In conclusion, shorter prostatic urethral length in preoperative MRI and a history of lower urinary tract symptoms were associated with a higher risk of climacturia following robot-assisted laparoscopic radical prostatectomy.

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Fig. 1: Pelvic floor MRI measurements.
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The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We extend our sincere gratitude to Henry Antonio Andrade, from the Statistical Support Service at FISEVI, for his invaluable support and expertise. His meticulous assistance in obtaining and analysing the statistical data was instrumental in shaping this research. His commitment has significantly contributed to the quality and rigour of this article. The authors declare that this research was conducted without the support of any external funding or financial assistance.

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Authors and Affiliations

  1. Department of Urology, Virgen del Rocío University Hospital, Calle Manuel Siurot, Seville, Spain

    Carmen Muñoz-Calahorro, Cristina García-Sánchez, Maria del Loreto Parra López, José María Lozano-Blasco & Rafael Antonio Medina-López

  2. Department of Radiology, Virgen del Rocío University Hospital, Calle Manuel Siurot, Seville, Spain

    Mariano José Parada-Blázquez & Leticia López-Arellano

  3. Escuela Internacional de Doctorado, Programa de Investigación, Faculty of Medicine, Universidad de Sevilla, Seville, Spain

    Carmen Muñoz-Calahorro, Cristina García-Sánchez & Rafael Antonio Medina-López

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  1. Carmen Muñoz-Calahorro
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Contributions

CMC was responsible for designing the research protocol, writing the protocol and report, conducting the research, performing the MRI measurements, extracting and analysing data, interpreting results and writing the report. CGC was responsible for designing the review protocol, performing the MRI measurements, and providing feedback on the report. MJPB and LLA were responsible for performing the MRI measurements. MLPL and JMLB were responsible for contributing to the research idea and protocol and providing feedback on the report. RAML was responsible for providing feedback on the research protocol and on the report.

Corresponding author

Correspondence to Carmen Muñoz-Calahorro.

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Competing interests

The authors declare no competing interests.

Ethical approval

The present research was conducted in concordance with the Helsinki Declaration and was reviewed and approved by the “Comité de Ética e Investigación de los hospitales universitarios Vírgen Macarena-Virgen del Rocío”. Verification code:81e241ec3fb742fe2b5c352bc9c12ca82b6fdc9d. Informed consent was obtained by all subjects when they were enrolled.

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Muñoz-Calahorro, C., Parada-Blázquez, M.J., García-Sánchez, C. et al. Shorter prostatic urethral length in preoperative Magnetic Resonance Imaging is associated with higher risk of climacturia following robot-assisted laparoscopic radical prostatectomy. Int J Impot Res (2024). https://doi.org/10.1038/s41443-024-00974-8

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