Department of Urology, University of Pisa, Pisa, Italy.
J Sex Med. 2012 Aug;9(8):2150-6. doi: 10.1111/j.1743-6109.2012.02829.x. Epub 2012 Jul 3.
Orgasm-Associated Incontinence (OAI) or climacturia has been observed in male patients maintaining sexual potency after radical prostatectomy and cystectomy.
We investigated the incidence and video-urodynamic aspects of this event in continent and potent patients after bladder neck-sparing (BNS) radical prostatectomy (RP).
Comparing functional and morphological aspects between climacturic and non-climacturic patients to identify a possible explanation of this unusual kind of leakage that could seriously impact the sexual life after surgery.
In a pool of 84 men, potent and continent at least 1 year after BNS RP, 24 (28.6%) reported climacturia and 7 agreed to undergo video-urodynamic evaluation (group 1), which was performed also in 5 controls (group 2). Those 12 men were also evaluated with 24-hour pad test, 5-item International Index of Erectile Function and International Prostate Symptom Score questionnaires.
Functional urethral length (FUL) was significantly lower in the climacturia group (P=0.02) and time to continence recovery was significantly longer (P=0.05). No other significant differences were found between the two groups. The radiological appearance of the vesicourethral junction at voiding cystourethrography was similar.
To the best of our knowledge, this is the first functional and morphological evaluation of climacturia after RP. In our experience, this event is indirectly associated with a reduced FUL in the sphincter area, although both patients and controls were continent during daily activities. BNS technique seems to reduce time to continence recovery, although climacturic patients need longer time than control patients. Since in our series no rigidity of the vesicourethral anastomosis was radiographically evident, we believe that differences in FUL could explain OAI. Anatomical difference in membranous urethra length could explain the occurrence of this symptom in patients treated with the same surgical technique.
在根治性前列腺切除术和膀胱切除术保持性能力的男性患者中，已经观察到与性高潮相关的尿失禁（OAI）或排尿后高潮。
我们研究了保留膀胱颈（BNS）根治性前列腺切除术（RP）后有控尿和有性能力的患者中这种事件的发生率和视频尿动力学表现。
比较排尿后高潮和非排尿后高潮患者的功能和形态方面，以确定对这种手术后严重影响性生活的异常漏尿的可能解释。
在 84 名至少在 BNS RP 后 1 年有控尿和有性能力的男性患者中，24 名（28.6%）报告有排尿后高潮，其中 7 名同意接受视频尿动力学评估（第 1 组），5 名对照组（第 2 组）也进行了同样的评估。这 12 名男性还接受了 24 小时垫试验、5 项国际勃起功能指数和国际前列腺症状评分问卷评估。
排尿后高潮组的功能性尿道长度（FUL）明显较低（P=0.02），恢复控尿的时间明显较长（P=0.05）。两组间无其他显著差异。排尿性膀胱尿道造影的膀胱尿道交界处的影像学表现相似。
据我们所知，这是 RP 后排尿后高潮的首次功能和形态学评估。根据我们的经验，尽管患者和对照组在日常活动中都有控尿能力，但这种事件与括约肌区域的 FUL 减少间接相关。BNS 技术似乎减少了恢复控尿的时间，但排尿后高潮患者比对照组患者需要更长的时间。由于在我们的系列中，没有可见的膀胱尿道吻合处僵硬，我们认为 FUL 的差异可以解释 OAI。膜部尿道长度的解剖差异可以解释在接受相同手术技术治疗的患者中发生这种症状的原因。
