Gamberini Pedro Daher Carneiro, Nascimento Bruno Chiesa Gouveia, Filho Homero Ribeiro, Nahas William, de Bessa Junior José, Teixeira Thiago Afonso, Hallak Jorge
Clinical Hospital of the Federal University of Espírito Santo, Vitória-ES, Brazil.
Clinical Hospital of the School of Medicine of the University of São Paulo, São Paulo, Brazil, São Paulo.
Int Urol Nephrol. 2025 Jan;57(1):115-120. doi: 10.1007/s11255-024-04181-8. Epub 2024 Aug 17.
After radical prostatectomy (RP), it is rarely acknowledged that several sexual dysfunctions can arise. These include issues in the orgasmic domain (e.g., decreased orgasm intensity, dysorgasmia), problems with ejaculation (e.g., absence of ejaculation), the development of penile deformities, and low sexual desire. This article aims to report the occurrence of orgasmic and ejaculatory dysfunction when actively investigated, documenting those rates and characterizing specific features of these conditions following RP.
This study has analyzed retrospective data from men who underwent RP and were experiencing erectile dysfunction. During a structured visit, patients were systematically questioned about dysorgasmia, altered orgasmic sensation, climacturia, and arousal incontinence. Continuous variables were analyzed using the Student T or ANOVA tests, while categorical variables were analyzed using Chi-squared or Fisher's exact tests. The associations were described as odds ratios with precise confidence intervals. All tests were two sided; a p value < 0.05 was considered statistically significant.
Sixty patients were included, out of which 3 (5%) reported dysorgasmia, while 33.3% presented a decrease in orgasm intensity. Climacturia was reported as the most common orgasmic disorder in 40 (66.6%) patients. However, only 14 patients (35%) reported that it frequently occurs, i.e., more than half of the time. Among the patients who reported climacturia, 72.5% classified it as mild losses. Additionally, arousal incontinence (AI) was noted in the study by 19 (26.3%) patients.
Our study highlights the importance of discussing orgasmic dysfunctions after RP, which can be frequent and bothersome but are often overlooked in preoperative counseling.
根治性前列腺切除术后（RP），很少有人认识到可能会出现多种性功能障碍。这些障碍包括性高潮方面的问题（如性高潮强度降低、性高潮障碍）、射精问题（如无射精）、阴茎畸形的发展以及性欲低下。本文旨在报告在积极调查时性高潮和射精功能障碍的发生情况，记录这些发生率并描述RP后这些情况的具体特征。
本研究分析了接受RP且患有勃起功能障碍的男性的回顾性数据。在一次结构化访视中，系统询问患者有关性高潮障碍、性高潮感觉改变、性高潮期排尿、性唤起失禁等问题。连续变量采用Student T检验或方差分析进行分析，分类变量采用卡方检验或Fisher精确检验进行分析。关联以具有精确置信区间的比值比来描述。所有检验均为双侧检验；p值<0.05被认为具有统计学意义。
纳入60例患者，其中3例（5%）报告有性高潮障碍，而33.3%的患者性高潮强度降低。40例（66.6%）患者报告性高潮期排尿是最常见的性高潮障碍。然而，只有14例患者（35%）报告其频繁发生，即超过一半的时间。在报告有性高潮期排尿的患者中，72.5%将其归类为轻度失禁。此外，19例（26.3%）患者在研究中被发现有性唤起失禁（AI）。
我们的研究强调了讨论RP后性高潮功能障碍的重要性，这些障碍可能很常见且令人困扰，但在术前咨询中常常被忽视。
