Efficacy of a penile variable tension loop for improving climacturia after radical prostatectomy

Abstract

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Climacturia is present in ∼20-40% of men after radical prostatectomy, and adversely affects sexual satisfaction. Although several strategies have been proposed for the treatment of climacturia, none have been systematically studied to date. This observational study shows that use of a penile variable tension loop can significantly reduce the degree and frequency of orgasm-associated incontinence, and the associated distress experienced by patients and partners. Climacturia resolves completely in half the patients, and occurs occasionally or rarely in the remainder.

Objective: To define the impact of the use of a penile variable tension loop on climacturia and on the distress level experienced by patients and their partners as a result of climacturia.

Patients and methods: All patients presenting for sexual function assessment after radical prostatectomy (RP) were questioned regarding climacturia. The study population consisted of men who had undergone RP < 6 months before initial evaluation, had reported having climacturia on ≥25% attempts where orgasm was achieved, had agreed to use the variable tension loop consistently, and continued to have climacturia when not using the loop at follow-up. Patients were interviewed regarding the frequency and degree of climacturia, and their own and their partner's distress levels secondary to climacturia, both with and without the use of the variable tension loop.

Results: The study population comprised 124 men. At baseline, the degree of climacturia was small, moderate, and large in 16%, 72%, 12% of patients, respectively, and 28%, 26% and 0%, respectively, at follow-up (all P < 0.01). Climacturia occurred rarely, occasionally, most of the time, or always in 15%, 48%, 16% and 21% of cases, respectively, at baseline, and 48% of patients experienced no climacturia with use of the variable tension loop. Distress was experienced by 14% and 61% of patients and partners at baseline, and 2% and 11% of patients and partners at follow up (P < 0.01). Severity of distress was significantly lower at follow-up for both partners and patients (P < 0.01).

Conclusions: Climacturia is a common complication of radical prostatectomy. Application of the variable tension loop can result in a significant decrease in the frequency and volume of climacturia. Use of the variable tension loop is a simple and non-invasive strategy for relieving the distress associated with climacturia in patients who have undergone RP and their partners.