Capogrosso Paolo, Ventimiglia Eugenio, Cazzaniga Walter, Montorsi Francesco, Salonia Andrea
Università Vita-Salute San Raffaele, Milan, Italy.
Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
World J Mens Health. 2017 Apr;35(1):1-13. doi: 10.5534/wjmh.2017.35.1.1.
In addition to urinary incontinence and erectile dysfunction, several other impairments of sexual function potentially occurring after radical prostatectomy (RP) have been described; as a whole, these less frequently assessed disorders are referred to as neglected side effects. In particular, orgasmic dysfunctions (ODs) have been reported in a non-negligible number of cases, with detrimental impacts on patients' overall sexual life. This review aimed to comprehensively discuss the prevalence and physiopathology of post-RP ODs, as well as potential treatment options. Orgasm-associated incontinence (climacturia) has been reported to occur in between 20% and 93% of patients after RP. Similarly, up to 19% of patients complain of postoperative orgasm-associated pain, mainly referred pain at the level of the penis. Moreover, impairment in the sensation of orgasm or even complete anorgasmia has been reported in 33% to 77% of patients after surgery. Clinical and surgical factors including age, the use of a nerve-sparing technique, and robotic surgery have been variably associated with the risk of ODs after RP, although robust and reliable data allowing for a proper estimation of the risk of postoperative orgasmic function impairment are still lacking. Likewise, little evidence regarding the management of postoperative ODs is currently available. In general, physicians should be aware of the prevalence of ODs after RP, in order to properly counsel all patients both preoperatively and immediately post-RP about the potential occurrence of bothersome and distressful changes in their overall sexual function.
除尿失禁和勃起功能障碍外，根治性前列腺切除术（RP）后还可能出现其他几种性功能损害；总体而言，这些较少评估的病症被称为被忽视的副作用。特别是，已有相当数量的病例报告了性高潮功能障碍（ODs），对患者的整体性生活产生了不利影响。本综述旨在全面讨论RP后ODs的患病率和病理生理学，以及潜在的治疗选择。据报道，RP后20%至93%的患者会出现性高潮相关的尿失禁（性高潮期遗尿）。同样，高达19%的患者抱怨术后性高潮相关疼痛，主要是阴茎部位的牵涉痛。此外，33%至77%的患者术后报告有性高潮感觉受损甚至完全性高潮缺失。临床和手术因素，包括年龄、保留神经技术的使用和机器人手术，与RP后ODs的风险存在不同程度的关联，尽管仍缺乏有力且可靠的数据来准确估计术后性高潮功能受损的风险。同样，目前关于术后ODs管理的证据也很少。一般来说，医生应该了解RP后ODs的患病率，以便在术前和RP后立即向所有患者妥善咨询其整体性功能可能出现的令人烦恼和痛苦的变化。
