Department of Urology, Tottori University Faculty of Medicine
Introduction: Among the sexual problems that may arise after radical prostatectomy (RP), erectile dysfunction has received the most attention. However, orgasmic dysfunction, such as orgasm-associated urinary incontinence (climacturia) and pain (dysorgasmia), anorgasmia, and altered perception of orgasm also occur in this context. The etiology of orgasmic dysfunction is not well understood, and it remains unclear how many and which patients with RP are affected, especially those who had robot-assisted radical prostatectomy (RARP). Therefore, the current study aimed to investigate the incidence and extent of orgasmic dysfunction in patients after the RARP, and identify the factors that can help predict patients at risk.
Methods: Between October 2010 and November 2019, we performed a single-center, cross-sectional, questionnaire-based investigation of patients who underwent RARP (n = 523). All the patients were treated at our institution between 3 and 111 months prior to beginning the study. Six questions on sexual activity, orgasmic function, altered perception of orgasms, dysorgasmia, and climacturia were developed. The questionnaires were mailed in February 2020, including a letter inviting patients to participate in the study. The primary outcome measure was the prevalence of orgasmic dysfunction. Predictive factors were identified using the logistic regression analyses.
Results: A total of 259 questionnaires were available for analysis. Among sexually active patients (n = 145), 33 (22.8%) reported anorgasmia, and 83 (57.2%) reported decreased orgasm intensity after versus before the RARP. Twenty-two (15.1%) patients reported dysorgasmia; among these patients, pain was experienced almost always or always in 13.6%, sometimes in 13.6%, and a few times in 72.8% of the cases. Climacturia was reported in 44 patients (30.3%). Urinary incontinence (odds ratio, 3.13; 95% confidence interval, 1.20-8.15) increased the risk of climacturia after the RARP.
Conclusions: These results indicate that orgasmic dysfunction after RARP is relatively common and should be considered by clinicians and researchers. It remains difficult to predict which patients are at risk before surgery. However, urinary incontinence can help identify patients who are at risk after RARP.
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