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Arousal Incontinence in Men Following Radical Prostatectomy: Prevalence, Impact and Predictors.

ABSTRACT: BACKGROUND:Arousal incontinence (AI) occurs during physical or psychological sexual stimulation in men and has been described after radical prostatectomy (RP). AIM:The goals of this study are to describe the characteristics of men experiencing AI, outline the nature of their symptoms, and assess for predictors of this condition. METHODS:A survey with questions on AI, stress urinary incontinence (SUI), the International Index of Erectile Function and International Prostate Symptom Score were sent out to men who had undergone an RP within the past 24 months at a single institution. The data were deidentified and analyzed using descriptive statistics. Comparisons between men with and without AI were made using t-tests and ?² and Fisher exact tests. Logistic regression in univariable and multivariable analyses were used to define predictors of AI. MAIN OUTCOME MEASURES:The outcomes of this study included prevalence of AI, symptom severity and timing, patient and patient-perceived partner bother, management strategies used by the patients, and concurrent SUI. RESULTS:226 (32%) men completed the survey. Of these men, almost half (49%) experienced AI at some point during their recovery. Improvement over time was endorsed by 62% of men. 57% of men reported AI in less than half of the sexual encounters, with the amount of urine leakage being equivalent to a tablespoon or less in 88% of men. On univariate analysis, increasing degree of SUI, as measured by pads per day, was associated with AI (P = .01). A lower International Prostate Symptom Score was also associated (P = .05). On multivariate analysis, the absence of hypertension and pads per day were associated with AI (P = .01 for both). CLINICAL IMPLICATIONS:AI occurred in almost half of the respondents in our series. Thus, AI should be discussed with patients before surgery to allow for realistic expectations. STRENGTHS & LIMITATIONS:Strengths of this study include the largest patient population analyzed to date regarding AI and that it is the only one to address timing and patient experiences with the use of validated instruments for erectile and urinary function. Limitations include single-center data, non-validated AI patient-reported outcomes, and poor survey response rate. CONCLUSION:Based on the available data, AI is reported by almost half of men after RP and is associated with SUI. Bach PV, Salter CA, Katz D, et al. Arousal Incontinence in Men Following Radical Prostatectomy: Prevalence, Impact and Predictors. J Sex Med 2020;16:1947-1952.

SUBMITTER: Bach PV

PROVIDER: S-EPMC7526796 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Arousal Incontinence in Men Following Radical Prostatectomy: Prevalence, Impact and Predictors.

Bach Phil Vu PV Salter Carolyn A CA Katz Darren D Schofield Elizabeth E Nelson Christian J CJ Mulhall John P JP

The journal of sexual medicine 20191115 12

<h4>Background</h4>Arousal incontinence (AI) occurs during physical or psychological sexual stimulation in men and has been described after radical prostatectomy (RP).<h4>Aim</h4>The goals of this study are to describe the characteristics of men experiencing AI, outline the nature of their symptoms, and assess for predictors of this condition.<h4>Methods</h4>A survey with questions on AI, stress urinary incontinence (SUI), the International Index of Erectile Function and International Prostate S ...[more]

PMID: 31735611

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Project description:IntroductionArousal 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.AimThe goal of this study was to assess the impact of AI on patient self-esteem, confidence, and sexual relationships.MethodsThis 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.OutcomesThe 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.ResultsFifty-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 implicationsAI leads to patient bother and avoidance of sexual situations.Strengths & limitationsThis 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.ConclusionAlthough 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.

Project description:IntroductionOrgasm-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.AimTo ascertain the prevalence and predictors of patient bother associated with climacturia.MethodsPatients 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 measureThe main outcome measures was the prevalence and predictors of climacturia-associated patient bother and perceived partner bother.ResultsClimacturia 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 implicationsGiven the prevalence of this condition and the bother associated with it, this complication should be discussed with patients preoperatively.Strength & limitationsStrengths 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.ConclusionClimacturia 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.

Project description:PurposeOne of the most frequent side effects of radical prostatectomy (RP) is urinary incontinence. The primary cause of urine incontinence is usually thought to be impaired urethral sphincter function; nevertheless, the pathophysiology and recovery process of urine incontinence remains unclear. This study aimed to identify potential risk variables, build a risk prediction tool that considers preoperative urodynamic findings, and direct doctors to take necessary action to reduce the likelihood of developing early urinary incontinence.MethodsWe retrospectively screened patients who underwent radical prostatectomy between January 1, 2020 and December 31, 2023 at the First People 's Hospital of Nantong, China. According to nomogram results, patients who developed incontinence within three months were classified as having early incontinence. The training group's general characteristics were first screened using univariate logistic analysis, and the LASSO method was applied for the best prediction. Multivariate logistic regression analysis was carried out to determine independent risk factors for early postoperative urine incontinence in the training group and to create nomograms that predict the likelihood of developing early urinary incontinence. The model was internally validated by computing the performance of the validation cohort. The nomogram discrimination, correction, and clinical usefulness were assessed using the c-index, receiver operating characteristic curve, correction plot, and clinical decision curve.ResultsThe study involved 142 patients in all. Multivariate logistic regression analysis following RP found seven independent risk variables for early urinary incontinence. A nomogram was constructed based on these independent risk factors. The training and validation groups' c-indices showed that the model had high accuracy and stability. The calibration curve demonstrates that the corrective effect of the training and verification groups is perfect, and the area under the receiver operating characteristic curve indicates great identification capacity. Using a nomogram, the clinical net benefit was maximised within a probability threshold of 0.01-1, according to decision curve analysis (DCA).ConclusionThe nomogram model created in this study can offer a clear, personalised analysis of the risk of early urine incontinence following RP. It is highly discriminatory and accurate, and it can help create efficient preventative measures and identify high-risk populations.

Project description:Background: D'Amico high-risk prostate cancer (Pca) patients experience poor and heterogeneous oncological outcomes. This heterogeneity highlights a need to extensively explore factors associated with poor outcomes to guide decision-making. Objective: To assess predictors of biochemical recurrence (BCR)-free survival in high-risk patients following radical prostatectomy (RP), and subsequently establish a model predicting outcomes. Methods: We retrospectively identified D'Amico high-risk non-metastatic Pca patients who underwent RP between 2013 and 2019 in our hospital. We collected data including PSA level, clinical stage, biopsy Gleason score (GS), number of D'Amico high-risk factors (RF), the inflammatory status (Neutrophil-to-lymphocyte ratio [NLR], derived NLR [dNLR], platelet-to-lymphocyte ratio [PLR] and LDH). Kaplan–Meier methods were used to analyze BCR-free survival. Univariate and multivariate analyses were performed using Cox proportional hazards model to evaluate the association between clinicopathological parameters and BCR-free survival. Results: The median follow-up time for the 101 patients' cohort was 26 months (range: 3–81 months). The number of RF (1RF vs. ?2RF), biopsy GS (<8 vs. ?8), clinical stage (?cT2c vs. >cT2c), pathological stage, and the presence of adverse pathological features were significant predictors of BCR (P < 0.05). Other parameters including inflammatory status (dNLR, NLR, PLR, and LDH) were not of predictive value. On multivariable analysis, biopsy GS (<8 vs. ?8; HR 2.439) and clinical stage (?cT2c vs. >cT2c; HR 3.271) were the independent predictors of BCR. Based on these two independent predictors, patients were stratified into three risk subgroups: favorable (0 risk factor; 47% of patients), intermediate (1 risk factor; 42 %), unfavorable (2 risk factors; 11%). The intermediate and unfavorable subgroups have a significantly shorter median BCR-free survival compared to the favorable subgroup (P < 0.001). Conclusion: Several factors are associated with BCR. Clinical stage (?cT2c vs. >cT2c) and biopsy GS (<8 vs. ?8) are the independent predictors of BCR. The stratification of high-risk patients into risk subgroups based on these two predictors shows that the intermediate and unfavorable subgroups have a significantly shorter median BCR-free survival compared to the favorable subgroup. The preoperative stratification model may help urologists and patients during decision-making. In non-metastatic high-risk patients, preoperative inflammatory markers (NLR, dNLR, PLR, and LDH) are not of prognostic value.

Dataset Information

Arousal Incontinence in Men Following Radical Prostatectomy: Prevalence, Impact and Predictors.

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Arousal Incontinence in Men Following Radical Prostatectomy: Prevalence, Impact and Predictors.

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