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Tarhan F, Erbay E, Sevinç BH, Tarcan T. Does Sexual Intercourse Position Have a Role in Occurrence of Coital Urinary Incontinence? Int Urogynecol J 2024:10.1007/s00192-024-05847-8. [PMID: 38922430 DOI: 10.1007/s00192-024-05847-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/02/2024] [Indexed: 06/27/2024]
Abstract
INTRODUCTION AND HYPOTHESIS This study was aimed at investigating the hypothesis that sexual intercourse positions may have an impact on the occurrence of coital urinary incontinence (CUI) in women. METHODS This case-control observational study enrolled 360 married, heterosexual, sexually active female participants with CUI. Each patient was evaluated using medical and sexual histories, questionnaires, physical examinations, and laboratory tests, including urodynamics. Participants were asked whether or not their intercourse positions had an impact on the occurrence of their CUI. Patients with intercourse position-dependent CUI were included in group 1, and those independent of it were allocated to group 2. The clinic and laboratory findings of the patient groups were compared. RESULTS The patients' mean age was 47.24 ± 0.57 years. Of these women, 28.9% (n = 104) were in group 1, and 71.1% (n = 256) were in group 2. Group 1 had a lower mean age, body mass index, Charlson comorbidity index, number of urinary incontinence episodes, severity of CUI and incontinence, and pad weight than group 2 (p < 0.05). The rates of detrusor overactivity and penetration type of CUI were higher in group 1 than in group 2 (p < 0.0009, p = 0.009 respectively). According to logistic regression analysis, the likelihood of sexual position-related CUI was 3.5 times higher in women with detrusor overactivity. CONCLUSIONS In certain patients, intercourse position is associated with the occurrence of CUI. This condition seems to be related to detrusor overactivity and is inversely associated with incontinence severity. However, further studies are necessary to explain this phenomenon.
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Affiliation(s)
- Fatih Tarhan
- Clinics of Urology, University of Health Sciences Kartal Dr. Lütfi Kırdar City Hospital, Balıkesir Caddesi, Aheste Sokak 2B/12, TR 34880, Kartal, Istanbul, Turkey.
| | - Erkan Erbay
- Faculty of Medicine, Department of Urology, Okan University, Istanbul, Turkey
| | - Burcu Hancı Sevinç
- Clinics of Urology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Tufan Tarcan
- Department of Urology, Marmara University School of Medicine and Department of Urology, Koç University School of Medicine, Istanbul, Turkey
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Roth JD, Hensel DJ, Wiener JS, Younsi N, Stein R, Misseri R, Szymanski KM. Urinary and Fecal Incontinence During Sexual Activity Is Common and Bothersome Among Adults With Spina Bifida. Urology 2024; 186:54-60. [PMID: 38354913 DOI: 10.1016/j.urology.2023.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To evaluate the prevalence of and risk factors for urinary fecal incontinence (UI, FI) during sexual activity (UIS, FIS) among adults with spina bifida (SB). METHODS An international online survey of adults with SB was administered through SB clinics and SB organizations via social media. Adults with a history of masturbation or partnered sexual activity were included. The primary outcome was ever experiencing UIS/FIS. Nonparametric tests and logistic regression were used for analysis. RESULTS A total of 341 adults met inclusion criteria (median age: 36years, 59% female, 52% shunted, 48% community ambulators). Baseline UI in the last 4weeks was reported by 50% and FI by 41%. Nineteen (5%) had a urostomy. Eight (2%) had a colostomy. Overall, 93% had a history of partnered genital contact. Among adults without a diversion, UIS was more common than FIS (70% vs 45%, P < .001). Among adults without a urostomy, UIS was more common among women (76% vs 62%, P = .01) and those with baseline UI (84% vs 50%, P < .001). UIS was not associated with age, shunt, ambulatory, or catheterization status (P >=.32). On bivariate analysis, female sex and baseline UI were independent predictors of UIS (P <=.001). Among adults without a colostomy, FIS was associated with female sex (50% vs 39%, P = .046), baseline FI (59% vs 32%, P < .001), community ambulation (52% vs 40%, P = .04), but not age, shunt, or MACE status (P >=.27). On multivariate analysis, baseline FI was independently associated with FIS (P < .001). Among adults with UIS/FIS, 29% experienced UIS "almost always" to "always," compared to 5% for FIS (P < .001). Virtually all adults found UIS/FIS bothersome (>=96% for each), even when incontinence occurred "almost never." UIS/FIS mostly occurred before and/or during orgasm than afterward (P < .001). UIS was reported by 53% of adults with a urostomy (100% bothersome). FIS was reported by 38% of adults with a colostomy (100% bothersome). CONCLUSION Incontinence during sexual activity is a common problem for men and women with SB. Baseline incontinence is an independent, but not absolute, predictor of both. While FIS is less frequent than UIS, both are virtually always bothersome.
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Affiliation(s)
- Joshua D Roth
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN.
| | - Devon J Hensel
- Department of Pediatrics and Department of Sociology, Indiana University School of Medicine and Indiana University Purdue University Indianapolis, Indianapolis, IN
| | - John S Wiener
- Division of Pediatric Urology, Department of Urology, Duke University Medical Center, Durham, NC
| | - Nina Younsi
- Department of Pediatric, Adolescent and Reconstructive Urology University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
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Gaither TW, Siapno AED, Kianian R, Vincent N, Williams KC, Piquerias E, Russell MM, Litwin MS. Relationship between pelvic sensations and lifetime exposure to receptive anal intercourse among people with prostates. J Sex Med 2023; 20:1195-1205. [PMID: 37548267 DOI: 10.1093/jsxmed/qdad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/06/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Despite the negative stigma on receptive anal intercourse (RAI), this behavior has a positive influence on individuals' sexual and relationship health. No large studies have previously looked at specific sensations experienced during RAI and how these sensations may change with experience. AIM In this study we aimed to quantify commonly reported pelvic sensations during RAI and determine whether their presentation changes with increasing experience of RAI. METHODS An internet survey was conducted on sensations felt during RAI among people with prostates from July 2022-January 2023. The survey content was developed based on a mixed-methods qualitative study and inquired about demographic and sexual histories as well as sensations (pleasure, pain, urinary, and bowel) experienced during RAI. We used descriptive statistics to describe demographic and sexual histories. All data were stratified by lifetime exposure to RAI. OUTCOMES The primary outcomes assessed included the quantification of both the primary sensations experienced during RAI and the associated bother. RESULTS In total, 975 participants completed the survey. The median age was 32 (range 18-78) years. The average age of first participation in RAI was 21 ± 6.6 years. Most respondents were having sex at least once a week (65%). Nine percent of respondents reported fewer than 10 experiences with RAI, 26% reported 11-50 RAI experiences, 32% reported 51-200 experiences, 16% reported 201-500 experiences, and 18% reported >500 experiences. As the number of experiences with RAI increased (from <10 to >500 exposures), the reported frequency of pleasurable sensation increased from 41% to 92% (P < .0001), whereas severe insertional pain and symptoms of bowel urgency decreased from 39% to 13% and from 21% to 6%, respectively (P < .0001). Urinary urgency sensation did not differ by lifetime RAI experience. CLINICAL IMPLICATIONS Lifetime RAI exposure can be readily assessed and correlates not only with pelvic sensation but also many other aspects of sexual health. These results imply that the etiology of dissatisfaction with pleasure or anodyspareunia during RAI may differ by lifetime RAI exposure. STRENGTHS AND LIMITATIONS This is the first study to our knowledge to assess pelvic sensations experienced during RAI among a large sample of individuals. This is a cross-sectional study, and we cannot conclude how pelvic sensations change over time among individuals. Internet-based participants may not be representative of clinical populations. CONCLUSION Lifetime exposure to RAI is positively associated with pleasure and is negatively associated with pain and bowel urgency. Pelvic sensations experienced during RAI appear to be dependent on lifetime RAI exposure history regardless of age.
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Affiliation(s)
- Thomas W Gaither
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Allen E D Siapno
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Reza Kianian
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
| | | | - Kristen C Williams
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Eduardo Piquerias
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Marcia M Russell
- Department of Surgery, Section of Colorectal Surgery, David Geffen School of Medicine, Los Angeles, CA 90095, United States
- Surgical and Perioperative Careline, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, United States
| | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States
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Kocjancic E, Chung E, Garzon JA, Haylen B, Iacovelli V, Jaunarena J, Locke J, Millman A, Nahon I, Ohlander S, Pang R, Plata M, Acar O. International Continence Society (ICS) report on the terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction. Neurourol Urodyn 2022; 41:140-165. [PMID: 34989425 DOI: 10.1002/nau.24846] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction has not been defined and organized into a clinically based consensus terminology report. The aim of this terminology report is to provide a definitional document within this context that will assist clinical practice and research. METHODS This report combines the input of the members of sexual health in men with LUT and PF Dysfunction working group of the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 18 rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus). The Committee retained evidence-based definitions, identified gaps, and updated or discarded outdated definitions. Expert opinions were used when evidence was insufficient or absent. RESULTS A terminology report for sexual health in men with LUT and PF dysfunction, encompassing 198 (178 NEW) separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different speciality groups involved. Conservative and surgical managements are major additions and appropriate figures have been included to supplement and clarify the text. Emerging concepts and measurements, in use in the literature and offering further research potential, but requiring further validation, have been included as an appendix. Interval (5-10 years) review is anticipated to keep the document updated. CONCLUSION A consensus-based terminology report for sexual health in men with LUT and PF dysfunction has been produced to aid clinical practice and research. The definitions that have been adopted are those that are most strongly supported by the literature at this time or are considered clinical principles or consensus of experts' opinions.
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Affiliation(s)
- Ervin Kocjancic
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Eric Chung
- Department of Urology, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | | | - Bernard Haylen
- Department of Gynaecology, University of New South Wales, Sydney, New South Wales, Australia
| | - Valerio Iacovelli
- Department of Urology, San Carlo di Nancy General Hospital-GVM Care and Research, Tor Vergata University of Rome, Rome, Italy
| | - Jorge Jaunarena
- Division of Urology, Centro de Urologia CDU, Instituto Alexander Fleming, Buenos Aires, Argentina
| | - Jennifer Locke
- Department of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Alexandra Millman
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Irmina Nahon
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Samuel Ohlander
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ran Pang
- Department of Urology, Guang An Men Hospital, Beijing, China
| | - Mauricio Plata
- Department of Urology, Universidad de los Andes School of Medicine, Fundación Santa fe de Bogotá University, Bogotá, Colombia
| | - Omer Acar
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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Mainwaring JM, Walker LM, Robinson JW, Wassersug RJ, Wibowo E. The Psychosocial Consequences of Prostate Cancer Treatments on Body Image, Sexuality, and Relationships. Front Psychol 2021; 12:765315. [PMID: 34744944 PMCID: PMC8568796 DOI: 10.3389/fpsyg.2021.765315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/22/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Joanna M Mainwaring
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Lauren M Walker
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - John W Robinson
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Richard J Wassersug
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Erik Wibowo
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
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Abstract
Oncosexology is a multidisciplinary field composed of physicians, nurses, psychologists, and other health care professionals focusing on sexual issues in patients with cancer. Although any cancer diagnosis or treatment can be associated with sexual dysfunction, pelvic malignancies (such as prostate, bladder, or colorectal cancer) have the highest rates of sexual dysfunction in men. This includes erectile dysfunction, testosterone deficiency, ejaculatory dysfunction, orgasmic dysfunction, sexual incontinence, and penile shortening. Testicular cancer and hematologic malignancies also have a significant impact on patients' sexual function. Health care providers should address sexual dysfunction with their patients, including any adverse effects of potential treatment options.
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Affiliation(s)
- Carolyn A Salter
- Male Sexual and Reproductive Medicine Program, Department of Urology, Memorial Sloan Kettering Cancer Center, 16 East. 60th Street, Suite 302, New York, NY 10022, USA
| | - John P Mulhall
- Male Sexual and Reproductive Medicine Program, Department of Urology, Memorial Sloan Kettering Cancer Center, 16 East. 60th Street, Suite 302, New York, NY 10022, USA.
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Kannady C, Clavell-Hernández J. Orgasm-associated urinary incontinence (climacturia) following radical prostatectomy: a review of pathophysiology and current treatment options. Asian J Androl 2021; 22:549-554. [PMID: 32167075 PMCID: PMC7705983 DOI: 10.4103/aja.aja_145_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Orgasm-associated urinary incontinence, or climacturia, is a common side effect after radical prostatectomy (RP) that is gaining more attention due to the distress it causes to patients. A range of treatment options have been reported in the literature and are outlined in this review. The goal of our study is to review the pathophysiology and current management options for climacturia following RP. A PubMed search was used to review the current literature relating to the pathophysiology and the treatment of postprostatectomy climacturia. We reviewed the currently available treatment options and their success rates for climacturia. Several techniques were found to subjectively help improve the amount and bother of patients' climacturia. These include pelvic floor muscle training (PFMT), penile variable tension loop, soft silicone occlusion loop, artificial urethral sphincter, male urethral sling, and the Mini-Jupette graft. Success rates ranged from 48% to 100% depending on the modality used. For patients with erectile dysfunction and climacturia, the Mini-Jupette graft could be a valuable option. Given the lack of validated measurement tools and management options, climacturia has become a challenge for urologists. Albeit a condition that has not garnered much attention, there are several management options from conservative to invasive treatments that have shown a hopeful promise for the treatment of climacturia. These options should be discussed with patients to determine the best treatment for each individual. More clinical trials are needed to assess the efficacy and impact of the different treatment options before a definitive recommendation regarding management can be made.
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Affiliation(s)
- Christopher Kannady
- Division of Urology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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The validity and reliability of the Turkish version of the 6-item female sexual function index (FSFI-6) and the relationship between climacturia and female sexual dysfunction. Int J Impot Res 2021; 34:610-613. [PMID: 34341519 DOI: 10.1038/s41443-021-00463-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/25/2021] [Accepted: 07/23/2021] [Indexed: 11/08/2022]
Abstract
This study aims to assess the validity and reliability of the Turkish version of the FSFI-6 questionnaire,an abbreviated version of FSFI-19,a common tool for evaluating female sexual function. The study included 120 female patients aged between 18-65 years who presented to the urology clinic between December 2019 and March 2020. The Turkish version of FSFI-6 was translated from the English version for validation. The abridged FSFI-6 questionnaire consists of questions 2, 4, 7, 11, 16, and 17 of the FSFI-19 form. We recorded the demographic data of the patients. All subjects filled out the FSFI-19 and FSFI-6 questionnaires. The patients were asked to fill out the questionnaires again after two weeks. The mean age of the subjects was 46.58 ± 9.89 years (28-63). The results of the reliability analysis indicated that the intraclass correlation coefficient of the total FSFI-6 score was 0.92 (weighted kappa coefficients of individual items, 0.868-0.975) and the Cronbach's alpha was 0.862. The validity analysis indicated that the mean total FSFI-6 score was strongly correlated with the mean FSFI-19 score (p < 0.001, r = 0.997). In the test-retest analysis,the kappa coefficient was calculated as 0.891. The FSFI-19 and FSFI-6 scores of the patients with (n = 52) and without climacturia (n = 68) were compared, and it was observed that the scores of the patients with climacturia were significantly lower than those without climacturia (p < 0.001). The abbreviated FSFI-6 questionnaire is a valuable tool for screening women with FSD. It can be used more extensively due to being short and easy to apply. Our results approve the Turkish version of the questionnaire as a valid and reliable tool for evaluating FSD.
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Mykoniatis I, van Renterghem K, Sokolakis I, Hatzichristodoulou G, Sempels M, Andrianne R. Climacturia: a comprehensive review assessing pathophysiology, prevalence, impact, and treatment options regarding the "leak of pleasure". Int J Impot Res 2021; 33:259-270. [PMID: 32203427 DOI: 10.1038/s41443-020-0257-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 12/19/2022]
Abstract
Aim of this review is to summarize and evaluate the current literature on the pathophysiology, prevalence, sociosexual impact, and potential treatment options of climacturia. Climacturia, defined as orgasm-associated urinary incontinence and characterized by great prevalence variability, ranging between 15.7 and 93% was, so far, a relatively neglected post-radical prostatectomy functional side-effect. Recent studies have shown that it can significantly impact the quality of life of couples after prostate cancer treatment. A knowledge gap characterizes the pathophysiologic pathways while treatment is based on empirically chosen treatment options (condom use, presexual intercourse urination) or on therapeutic modalities proposed by low-quality studies (pelvic floor muscle training, penile applied devices). Evidence regarding efficacy of surgical techniques (artificial urinary sphincter, male sling, or dual implantation of penile prosthesis with a sling) for climacturia treatment are limited but with an increasing trend of relevant published data in the last 5 years. The mini-jupette sling plus inflatable penile prosthesis placement is a promising surgical technique that has been studied in a multi-institutional cohort with encouraging results regarding climacturia, erectile dysfunction, and mild-incontinence control. However, future studies with longer follow-up and larger sample sizes are certainly needed to confirm the long-term safety and benefits of this intervention.
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Affiliation(s)
- Ioannis Mykoniatis
- Centre Hospitalier Universitaire de Liège, Service d'Urologie, Hasselt, Belgium.
- Department of Urology, Jessa Hospital, Hasselt, Belgium.
| | - Koenraad van Renterghem
- Department of Urology, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine, Hasselt University, Hasselt, Belgium
- University Hospitals Leuven, Leuven, Belgium
| | - Ioannis Sokolakis
- Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
| | | | - Maxime Sempels
- Centre Hospitalier Universitaire de Liège, Service d'Urologie, Hasselt, Belgium
| | - Robert Andrianne
- Centre Hospitalier Universitaire de Liège, Service d'Urologie, Hasselt, Belgium
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Ajay D, Mendez MH, Wang R, Westney OL. Treatment of Urinary Incontinence in Patients With Erectile Dysfunction. Sex Med Rev 2020; 9:593-604. [PMID: 32622885 DOI: 10.1016/j.sxmr.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Concurrent urinary incontinence (UI) and erectile dysfunction (ED) can greatly damage a patient's quality of life. Owing to the intertwined anatomy, treatment options for one most certainly have implications on the other. OBJECTIVE The aim of this review is to characterize and elucidate the treatment patients with postprostatectomy UI undergoing concurrent or subsequent treatment of ED. These principles can be extrapolated to all patients with UI and ED. METHODS The literature on postprostatectomy UI treatment in the context of concurrent ED was reviewed through a Medline search. Original research using quantitative and qualitative methodologies was considered. RESULTS The epidemiology, workup, and management of postprostatectomy UI being mindful of ongoing or future ED treatments are the main outcome measures. Owing to the intertwined anatomy, treatment options for UI and ED have implications on the other. It is essential for the surgeon to obtain an understanding of the patient's degree of bother for each process, personal preference on treatment options, and management of expectations. Surgical treatment options include a combination of the artificial urinary sphincter, sling, inflatable penile prosthesis, semi-rigid penile prosthesis, and new techniques such as the Mini-Jupette. The appropriate combinations will be determined by patient factors of dexterity, preference, degree of leakage, history of radiation, and so on. The decision of staged vs dual implant will be largely driven by the surgeons' preference, payor limitations, and comfort level. This issue is particularly challenging in redo cases where we advocate for cuff downsizing or tandem cuff before the transcorporal approach is used with the goal of preserving sexual function. CONCLUSION The concurrent treatment of ED and UI requires thoughtful workup, meticulous attention to detail, and an armamentarium of surgical skills. It is crucial for the surgeon to understand and manage patient expectations in treating these delicate and difficult pathologies. Ajay D, Mendez MH, Wang R, et al. Treatment of Urinary Incontinence in Patients With Erectile Dysfunction. J Sex Med 2020;XX:XXX-XXX.
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Affiliation(s)
- Divya Ajay
- Urinary Tract and Pelvic Reconstruction fellow, Department of Urology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
| | - Melissa H Mendez
- Sexual Medicine and Genital Reconstruction fellow, Department of Urology, University of South Florida, Tampa, FL, USA
| | - Run Wang
- Professor, Department of Urology, University of Texas McGovern Medical School and MD Anderson Cancer Center, Houston, TX, USA
| | - O Lenaine Westney
- Professor, Department of Urology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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Jimbo M, Alom M, Pfeifer ZD, Haile ES, Stephens DA, Gopalakrishna A, Ziegelmann MJ, Viers BR, Trost LW, Kohler TS. Prevalence and Predictors of Climacturia and Associated Patient/Partner Bother in Patients With History of Definitive Therapy for Prostate Cancer. J Sex Med 2020; 17:1126-1132. [PMID: 32179016 DOI: 10.1016/j.jsxm.2020.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Climacturia is an under-reported complication of definitive therapy for prostate cancer (PCa) - that is, radical prostatectomy (RP) and/or radiation therapy (RT). AIM We sought to identify the prevalence and predictors of climacturia and associated patient/partner bother in patients with and without prior PCa treatment. METHODS We analyzed a database of patients who presented to our Men's Health clinic and filled out a questionnaire related to sexual function and pertinent medical histories. The prevalence of climacturia and associated patient/partner bother in patients with/without prior RP/RT was calculated. Univariable and multivariable logistic regressions were performed to identify predictors associated with climacturia and patient/partner bother. OUTCOMES The primary outcomes were the prevalence and predictors of climacturia and associated patient/partner bother in patients with/without history of definitive PCa treatment. RESULTS Among 1,117 patients able to achieve orgasm, 192 patients (17%) had prior history of definitive therapy for PCa (RP alone = 139 [72%]; RT alone = 22 [11%]; RP + RT = 31 [16%]). Climacturia was reported by 39%, 14%, 52%, and 2.4% of patients with history of RP alone, RT alone, RP + RT, and neither RP nor RT, respectively (P < .05 between all groups). 33 to 45 percent of patients with climacturia noted significant patient/partner bother. Factors significantly associated with climacturia were prior RP, prior RT, history of other prostate surgery, and erectile dysfunction, although erectile dysfunction was not significant on multivariable analysis. Significant reduction in climacturia prevalence was noted for patients who were ≥1 year out from RP, compared with patients who were <1 year out. Among patients with prior RP/RT, stress urinary incontinence was associated with increased risk of climacturia, whereas diabetes was associated with decreased risk. No factors were associated with patient/partner bother. Among patients with prior RP, nerve-sparing technique did not predict presence of climacturia but was associated with reduced patient/partner bother. CLINICAL TRANSLATION Given significant prevalence of climacturia and associated patient/partner bother, patients should be counseled on the risk of climacturia before undergoing RP/RT. STRENGTHS AND LIMITATIONS Strengths include the large study population and the focus on both RP and RT. Limitations include the facts that this is a single-institution study that primarily relies on patients' subjective reporting and that the study population may not represent the general population. CONCLUSIONS Climacturia affects a significant proportion of patients with history of RP/RT for PCa, and many patients and their partners find this bothersome. Jimbo M, Alom M, Pfeifer ZD, et al. Prevalence and Predictors of Climacturia and Associated Patient/Partner Bother in Patients With History of Definitive Therapy for Prostate Cancer. J Sex Med 2020;17:1126-1132.
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Affiliation(s)
- Masaya Jimbo
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Manaf Alom
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Zachary D Pfeifer
- Department of Urology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Eiftu S Haile
- Department of Urology, Rush Medical College, Chicago, IL, USA
| | - Dane A Stephens
- Department of Urology, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | | | | | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, MN, USA
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Salter CA, Bach PV, Miranda E, Jenkins LC, Benfante N, Schofield E, Nelson CJ, Mulhall JP. Bother Associated With Climacturia After Radical Prostatectomy: Prevalence and Predictors. J Sex Med 2020; 17:731-736. [PMID: 31973900 DOI: 10.1016/j.jsxm.2019.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/18/2019] [Accepted: 12/15/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Orgasm-associated incontinence, climacturia, is one of the lesser studied radical prostatectomy (RP) complications. Little is known about patient bother related to this condition, specifically, its prevalence and predictors. AIM To ascertain the prevalence and predictors of patient bother associated with climacturia. METHODS Patients presenting for the evaluation of sexual dysfunction after RP at a single center were queried on various domains of sexual dysfunction. This included orgasmic dysfunction and sexual incontinence (including climacturia and arousal incontinence). Patients were specifically asked about the frequency and amount of climacturia. In addition, questions addressed patient bother and the perceived bother of their partners. Descriptive statistics were used for patient characteristics. A t-test was used for comparing the frequency of patient and partner bother, and the Pearson correlation test compared relationships between bother and predictors. Multivariable analysis was conducted to define predictors of climacturia-associated bother. MAIN OUTCOME MEASURE The main outcome measures was the prevalence and predictors of climacturia-associated patient bother and perceived partner bother. RESULTS Climacturia was reported by 23% of 3,207 consecutive men analyzed. Bother of any degree was experienced by 45% of these patients, and 14% reported partner bother related to this condition. Patient bother was associated with perceived partner bother (P < .001) and inversely correlated with relationship duration (P < .001). The overall frequency and quantity of climacturia were also predictive (P < .001 for both). In the adjusted model, all of these factors remained significant. CLINICAL IMPLICATIONS Given the prevalence of this condition and the bother associated with it, this complication should be discussed with patients preoperatively. STRENGTH & LIMITATIONS Strengths include a large study population and specific questions on climacturia-associated bother. Limitations include the fact that it is a single-center study and no direct partner questioning occurred. CONCLUSION Climacturia and its associated bother are common after RP. The predictors of patient bother include perceived partner bother, shorter relationship duration, and increasing frequency and quantity of climacturia. Salter CA, Bach PV, Miranda E, et al. Bother Associated With Climacturia After Radical Prostatectomy: Prevalence and Predictors. J Sex Med 2020;17:731-736.
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Affiliation(s)
- Carolyn A Salter
- Sexual & Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Phil Vu Bach
- Sexual & Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Division of Urology, Department of Surgery, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - Eduardo Miranda
- Sexual & Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Division of Urology, Federal University of Ceará, Ceará, Brazil
| | - Lawrence C Jenkins
- Sexual & Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Urology Service, Ohio State University, Columbus, OH, USA
| | - Nicole Benfante
- Sexual & Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth Schofield
- Departments of Psychiatry/Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian J Nelson
- Departments of Psychiatry/Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John P Mulhall
- Sexual & Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Salter CA, Bach PV, Katz D, Schofield E, Nelson CJ, Mulhall JP. The Relationship and Psychosocial Impact of Arousal Incontinence After Radical Prostatectomy. J Sex Med 2019; 17:94-98. [PMID: 31735619 DOI: 10.1016/j.jsxm.2019.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Arousal incontinence (AI) is a lesser known complication of radical prostatectomy (RP), and few data are available on its impact on self-esteem and sexual relationships. AIM The goal of this study was to assess the impact of AI on patient self-esteem, confidence, and sexual relationships. METHODS This was a retrospective study. The validated Self-Esteem and Relationship (SEAR) questionnaire, as well as questions regarding AI, stress urinary incontinence (SUI), climacturia, International Prostate Symptom Score, and the International Index of Erectile Function erectile function domain, were sent to men who had undergone an RP within the past 24 months at a single institution. The data were de-identified and analyzed using descriptive statistics. OUTCOMES The outcomes of this study include prevalence of AI, SEAR domain scores, patient and partner bother, management strategies employed by the patients, and the presence of concurrent climacturia or SUI. RESULTS Fifty-three percent of men experienced post-operative AI; of these, 41% were currently experiencing AI, and 12% reported having prior AI that had resolved. Bother of any severity was reported by 87% of men, and perceived partner bother was reported by 64% of men. Forty-one percent of men with current AI avoided sexual activity due to the presence of AI, and 14% of men with prior AI still avoided intercourse. There was no difference in total SEAR score or in the subdomains of self-esteem, sexual relationship, or confidence between men with current AI compared to those with no AI. CLINICAL IMPLICATIONS AI leads to patient bother and avoidance of sexual situations. STRENGTHS & LIMITATIONS This is the largest study specifically evaluating AI and the only study assessing its impact on self-esteem, sexual relationships, and self-confidence. Limitations include lack of a validated AI questionnaire, poor survey response rate, being a single-center study, and the potential for recall bias. CONCLUSION Although AI is a common occurrence post-RP and is associated with patient bother in the majority of men, it does not impact overall self-esteem, confidence, or sexual relationships compared to post-RP men who have not experienced AI. Salter CA, Bach PV, Katz D, et al. The Relationship and Psychosocial Impact of Arousal Incontinence After Radical Prostatectomy. J Sex Med 2020;17:94-98.
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Affiliation(s)
- Carolyn A Salter
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Phil Vu Bach
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Darren Katz
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John P Mulhall
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY.
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Impact of Overactive Bladder-Wet Syndrome on Female Sexual Function: A Systematic Review and Meta-Analysis. Sex Med Rev 2019; 7:565-574. [PMID: 31326358 DOI: 10.1016/j.sxmr.2019.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/15/2019] [Accepted: 05/18/2019] [Indexed: 11/23/2022]
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Dantas TH, Castaneda L, Correia GN, Campelo CLDC, Sousa Dantas D. Functioning and disability of premenopausal women with urinary incontinence: An assessment by using the World Health Organization Disability Assessment Schedule—WHODAS 2.0. Neurourol Urodyn 2019; 38:1767-1774. [DOI: 10.1002/nau.24073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 05/19/2019] [Accepted: 05/27/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Thaissa Hamana Dantas
- Postgraduate Program of Rehabilitation Sciences, Faculty of Health Sciences of TrairiFederal University of Rio Grande do NorteNatal Brazil
| | - Luciana Castaneda
- Federal Institute of EducationScience and Technology of Rio de JaneiroNiterói Brazil
| | - Grasiéla Nascimento Correia
- Postgraduate Program of Rehabilitation Sciences, Faculty of Health Sciences of TrairiFederal University of Rio Grande do NorteNatal Brazil
| | | | - Diego Sousa Dantas
- Postgraduate Program of Rehabilitation Sciences, Faculty of Health Sciences of TrairiFederal University of Rio Grande do NorteNatal Brazil
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Abstract
Radical prostatectomy, the preferred treatment option for organ-confined prostate cancer, is associated with a wide variety of sexual dysfunctions including erectile and orgasmic dysfunctions. Climacturia is a type of orgasmic dysfunction that has been reported to occur in 20-60% of men after radical prostatectomy. Several treatment strategies for climacturia have been evaluated and recommended including behavioral changes, use of special devices, medications, specialized therapies, and surgeries. Inflatable penile prosthesis implantation might be the treatment of choice when conservative management approaches fail to treat erectile dysfunction. In this review article, the different options and approaches for the management of climacturia during inflatable penile prosthesis surgery will be discussed.
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Bovbjerg ML. Current Resources for Evidence-Based Practice, March 2019. J Obstet Gynecol Neonatal Nurs 2019; 48:230-248. [PMID: 30735623 DOI: 10.1016/j.jogn.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A review of new resources to support the provision of evidence-based care for women and infants.
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Development and validity of a questionnaire for coital urinary incontinence: clinical and urodynamic analysis. Int Urogynecol J 2019; 30:2141-2148. [PMID: 30627831 DOI: 10.1007/s00192-018-03863-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To develop and validate a questionnaire (coital incontinence questionnaire-CIQ) for CI and perform clinical and urodynamic analysis of patients with CI. METHODS A total of 414 female patients with urinary incontinence undergoing urodynamics were included in this study. All patients were evaluated with a detailed history, questionnaires, physical examination, relevant laboratory tests and urodynamics. Content, construct and convergent validity of the questionnaire were evaluated. Patients were divided into groups: with CI (group 1) and without CI (group 2). RESULTS Overall test-retest reliability coefficients of CIQ were high (r = 0.968, p = 0.01), and the internal consistency was excellent (Cronbach's alpha, 0.964). The test-retest scores did not show a statistically significant difference (p = 0.158). Approximately 34% of these women had CI. Body mass index (BMI), parity, daily incontinence episodes, daily pad counts and 1-h pad test results were higher in group 1 than group 2 (p < 0.05). Multivariate analysis revealed that a daily incontinence episode, BMI, maximum cystometric capacity and PdetQmax were statistically significant factors associated with CI. Urinary incontinence types were different between groups (p < 0.0001). Incontinence with both penetration and orgasm was the most common form of CI (54.4%), and CI severity differed significantly among the forms of CI (p = 0.007). CI negatively interferes with patients' sexual life, their relationship with their partner and quality of life in most patients. CONCLUSIONS The CIQ is a reliable, valid and useful tool for assessment of all aspects of CI in women. CI seems to be related to the severity of urinary incontinence. Further studies are needed to clarify this subject.
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Barton GJ, Carlos EC, Lentz AC. Sexual Quality of Life and Satisfaction With Penile Prostheses. Sex Med Rev 2019; 7:178-188. [DOI: 10.1016/j.sxmr.2018.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/08/2018] [Accepted: 10/13/2018] [Indexed: 10/27/2022]
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Moutounaïck M, Miget G, Teng M, Kervinio F, Chesnel C, Charlanes A, Le Breton F, Amarenco G. [Coital incontinence]. Prog Urol 2018; 28:515-522. [PMID: 29866492 DOI: 10.1016/j.purol.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Urinary incontinence may seriously impact quality of life, self-image and subsequently the sexual life. Beside this fact, urinary leakage can specifically occur during sexual intercourse, formally named coital incontinence, and thus lead to specific alteration of the sexual life. AIM To analyse the prevalence, pathophysiological mechanisms and possible therapeutic options for coital urinary incontinence. METHODS Related terms to urinary incontinence and sexual dysfunction were search on PubMed database. RESULTS Whereas at least a quarter of incontinent women have a coital incontinence, this symptom was rarely spontaneously reported. Some women had only coital incontinence (7.6 to 20% of cases). In men, urinary incontinence during sexual intercourse was mainly observed after prostatectomy in 20 to 64% of cases. Coital incontinence requires precise assessment. Indeed, it can occur whatever the phase of coitus: local stimulation (20-30%), excitement (13-18%), penetration (62.9-68%), movements back and forth, orgasm (27-37.1%). Cervico-urethral hypermobility, sphincter incompetence, urethral instability, detrusor overactivity could be the principal physiopathological mechanisms. In men, the main cause was a stress incontinence secondary to sphincter deficiency. Specific therapeutic strategies have proved their effectiveness. The rehabilitative approach (RR=0.25, CI [0.06-1.01]), medicinal (anticholinergic were effective in 59% of cases) or surgical therapeutic (slings with an efficiency of 87%) was proposed to patients. CONCLUSION Coital incontinence is a common and troublesome symptom. Its precise assessment may suggest a specific mechanism and thus a specific treatment.
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Affiliation(s)
- M Moutounaïck
- Groupe de recherche clinique en neuro-urologie (GREEN), GRC 01, Sorbonne universités, 75006 Paris, France; Service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France.
| | - G Miget
- Groupe de recherche clinique en neuro-urologie (GREEN), GRC 01, Sorbonne universités, 75006 Paris, France; Service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - M Teng
- Groupe de recherche clinique en neuro-urologie (GREEN), GRC 01, Sorbonne universités, 75006 Paris, France; Service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - F Kervinio
- Groupe de recherche clinique en neuro-urologie (GREEN), GRC 01, Sorbonne universités, 75006 Paris, France; Service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - C Chesnel
- Groupe de recherche clinique en neuro-urologie (GREEN), GRC 01, Sorbonne universités, 75006 Paris, France; Service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - A Charlanes
- Groupe de recherche clinique en neuro-urologie (GREEN), GRC 01, Sorbonne universités, 75006 Paris, France; Service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - F Le Breton
- Groupe de recherche clinique en neuro-urologie (GREEN), GRC 01, Sorbonne universités, 75006 Paris, France; Service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - G Amarenco
- Groupe de recherche clinique en neuro-urologie (GREEN), GRC 01, Sorbonne universités, 75006 Paris, France; Service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
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Yafi FA, Andrianne R, Alzweri L, Brady J, Butcher M, Chevalier D, DeLay KJ, Faix A, Hatzichristodoulou G, Hellstrom WJG, Jenkins L, Kohler TS, Osmonov D, Park SH, Schwabb MD, Valenzuela R, van Renterghem K, Wilson SK. Andrianne Mini-Jupette Graft at the Time of Inflatable Penile Prosthesis Placement for the Management of Post-Prostatectomy Climacturia and Minimal Urinary Incontinence. J Sex Med 2018. [PMID: 29523479 DOI: 10.1016/j.jsxm.2018.01.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND After radical prostatectomy (RP), erectile dysfunction, often necessitating the need for inflatable penile prosthesis (IPP) insertion, and urinary incontinence and climacturia can ensue. AIM To assess the efficacy and safety of the mini-jupette, a mesh used to approximate the medial aspects of the 2 corporotomies at the time of IPP insertion, for the management of climacturia and urine leakage in patients with minimal incontinence. METHODS We conducted a pilot multicenter study of patients with post-RP erectile dysfunction and climacturia and/or mild urinary incontinence (≤2 pads/day [ppd]) undergoing IPP insertion with concomitant placement of a mini-jupette graft. OUTCOMES Pre- and postoperative erectile function, continence and climacturia, and overall surgical outcomes were assessed. RESULTS 38 patients underwent the mini-jupette procedure. The mean age of the population was 65.3 years (SD = 7.7). 30 had post-RP climacturia and 32 patients had post-RP incontinence (mean = 1.3 ppd, SD = 0.8). 31 patients received Coloplast Titan, 4 received AMS 700 LGX, and 3 received AMS 700 CX IPPs. Mean corporotomy size was 2.9 cm (SD = 1.0). Mean graft measurements were 3.2 cm (SD = 0.9) for width, 3.3 cm (SD = 1.3) for length, and 11.0 cm2 (SD = 5.1) for surface area. At a mean follow-up of 5.1 months (SD = 6.9), there were 5 postoperative complications (13.2%) of which 4 required explantation. Climacturia and incontinence were subjectively improved in 92.8% and 85.7%, respectively. Mean ppd decreased by 1.3 postoperatively. CLINICAL IMPLICATIONS The Andrianne mini-jupette is a feasible adjunct to IPP placement that can be used for subsets of patients with post-RP climacturia and/or minimal incontinence. STRENGTHS AND LIMITATIONS Strengths of this study include the novel nature of this intervention, the multi-institutional nature of the study, and the promising results demonstrated. Limitations include the retrospective nature of the study and the heterogeneity of the techniques and grafts used by different surgeons involved. CONCLUSION Longer follow-up and larger patient cohorts are needed to confirm the long-term safety and benefits of this intervention. Yafi FA, Andrianne R, Alzweri L, et al. Andrianne Mini-Jupette Graft at the Time of Inflatable Penile Prosthesis Placement for the Management of Post-Prostatectomy Climacturia and Minimal Urinary Incontinence. J Sex Med 2018;15:789-796.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sun Hung Park
- Sewum Prosthetic Urology Center of Excellence, Seoul, Korea
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