[Modification of sexual desire and orgasm after radical prostatectomy for prostate cancer]

Climacturia After Radical Prostatectomy: MRI-Based Predictors

BACKGROUND

After radical prostatectomy (RP), climacturia is a prevalent and distressing problem. To date, no specific predictors have been identified.

AIM

In this analysis, we sought to find associated pelvic magnetic resonance imaging (MRI) parameters.

METHODS

We identified all men in our departmental database who (i) had climacturia post-RP, ≥3 episodes; (ii) underwent a pre-RP endorectal MRI; (iii) had no radiation or androgen deprivation therapy (ADT). Soft tissue and bony dimensions were measured by 2 raters blinded to clinical and pathological data.

OUTCOMES

MRI parameters included the following: maximum height, width, and depth of prostate, prostate volume, urethral width and length, lower conjugate of pelvis, bony femoral width, outer and inner levator distances and thickness. Point-biserial correlations were run on univariate associations. Logistic regression was used for the multivariable model.

RESULTS

194 consecutive pre-RP MRI studies were reviewed (56 men with and 138 without climacturia). Mean age was 60 ± 7 years, average time post-RP at assessment, 7 ± 7 months. Of MRI parameters, urethral width (r = 0.13, P = .03) and lower conjugate (r = 0.12, P = .05) were associated with presence of persistent climacturia. 2 others met criteria for multivariable analysis, prostate depth and outer levator distance. Of the non-MRI parameters, none were significantly related to climacturia and only body mass index (BMI) met criteria for multivariable analysis. On multivariable analysis, only urethral width was associated with climacturia (OR = 1.23, 95% CI: 1.01-1.49, P = .04); the wider the urethra, greater the chance of climacturia.

CLINICAL IMPLICATIONS

Improved ability to predict the occurrence of orgasm-associated incontinence in the preoperative setting.

STRENGTHS AND LIMITATIONS

Limitations include the fact that the MRI endorectal probe may have distorted pelvic tissues during imaging and that our study population size was small. However, prospective data collection, blinded measurements by 2 trained readers, and rigorous statistical analysis should be considered strengths.

CONCLUSION

By identifying preoperative risk factors, such as urethral width on MRI, we may be able to better understand the pathophysiology of this condition and furthermore may permit us to better counsel men regarding this postoperative outcome. Sullivan JF, Ortega Y, Matsushita K, et al. Climacturia After Radical Prostatectomy: MRI-Based Predictors. J Sex Med 2020;17:1723-1728.

[Sexual consequences after treatment of prostate cancer: Inquiry among members of the Association Nationale des Malades du Cancer de la Prostate]

INTRODUCTION

Complications of prostate cancer treatments are responsible of a lower quality of life. We evaluated the prevalence and the perceptions of sexual consequences of prostate cancer treatments.

MATERIALS AND METHODS

A retrospective self-administered questionnaire was sent to all the members of the Association Nationale des Malades du Cancer de la Prostate (ANAMACAP). All the answers were analyzed.

RESULTS

226 questionnaires were analyzed, the average age was 67.3 years old, the average follow-up was 58.1 months. 110 patients had surgery only, 29 had hormone therapy plus radiotherapy, 28 had radiation therapy only and 49 had combined treatments. After the treatment of the prostate cancer, an erectile dysfunction was reported by 75.2% of the patients; an orgasmic dysfunction by 69%; a climacturia by 21%; a reduced penile length by 70% of them and a less sensitive glans by 59%. They were responsible of a lower quality of life for 75% to 90% of the patients depending on the symptom. A PDE5-inhibitor treatment was effective for only 25.6% of them when taken daily and for 39% on demand.

CONCLUSION

Functional consequences of prostate cancer treatments are common, diverse and directly involved in the sexual life. It is necessary to improve therapeutical education and onco-sexology with the help of patients' associations, to build a new balance in the couples.

LEVEL OF EVIDENCE

3.

Psychosocial perspectives on sexual recovery after prostate cancer treatment

Many therapies for erectile dysfunction (ED) after prostate cancer treatment improve erectile firmness, yet, most couples stop using aids within 1-2 years. Patients and partners who expect immediate and complete success with their first ED treatment can be demoralized when they experience treatment failure, which contributes to reticence to explore other ED aids. Comprehensive patient education should improve sustainability and satisfaction with ED treatments. Pre-emptive and realistic information should be provided to couples about the probability of recovering natural erections. Beginning intervention early and using a couple-based approach is ideal. Recommendations are provided about the timing of ED treatment, the order of aid introduction, and combination therapies. Renegotiation of sexual activity is an essential part of sexual adaptation. From the outset of therapy, couples should be encouraged to broaden their sexual repertoire, incorporate erection-independent sexual activities, and continue to be sexual despite ED and reduced libido.