Climacturia, also known as orgasm-associated incontinence, is a condition in which a man leaks urine as he ejaculates. Men who have had their prostate gland removed are likely to experience this side effect.
What Causes Climacturia?
The prostate is surrounded by nerves and tissue responsible for proper urinary and sexual function. If the nerves and tissue are damaged during radical prostatectomy (RP), patients may experience incontinence and erectile dysfunction.
The exact cause of climacturia after RP is unknown, but studies suggest the condition may be related to the removal of the internal urethral sphincter during RP in conjunction with external sphincter relaxation. Other potential causes and associations with climacturia include injury of the internal urethral sphincter and its supporting structures during RP surgery; loss of penile length, which could reflect the loss of prostatic urethral length; and orgasmic pain.
A recent survey of 3,207 men found:
- All participants were having sexual problems after undergoing a prostatectomy
- Nearly 25% had climacturia
- 70% leaked urine in drops
- Nearly 50% said climacturia occurred during 25% to 50% of their orgasms
- 45% of men with climacturia were bothered by their condition
- 15% of men with climacturia believed their partners were bothered by their condition
Some men manage the condition by emptying their bladder before sex or wearing a condom. For those who need treatment, options include:
- Variable tension penile loop. A loop made of soft silicone is placed over the penis before sex to help compress the urine channel and prevent incontinence during orgasm. The tension of the loop can be adjusted for comfort. A drawback of this treatment option is potential interference with sexual activity, causing discomfort, bruising, and superficial injuries.
- Pelvic floor muscle training (PFMT). A trained physical therapist will help build strength and endurance in the pelvic floor muscles.
- Surgery. An artificial urethral sphincter or a male urethral sling can help treat climacturia.
Another treatment option for climacturia is the Mini-Jupette sling. Patients who have not benefited from non-invasive treatment options and who continue to experience significant distress or embarrassment during sex may benefit from a Mini-Jupette sling.
The surgeon begins the procedure by making a penoscrotal or sub-coronal incision to access the urethra and the two corpora. Next, the surgeon will make a two-centimeter incision and place stay sutures. The surgeon will then create a Mini-Jupette sling and sew it into place with running non-absorbable sutures. A clamp will be placed under the sling to prevent over-tensioning. The surgeon may test the sling by inflating the cylinders or by performing a cystoscopy.
One study of 38 men who underwent the Mini-Jupette procedure showed that:
- 78.6% saw improvements in their incontinence and climacturia
- 75% achieved complete resolution of incontinence
- Nearly 68% had complete resolution of climacturia
- 92.8% reported subjective improvement
Possible side effects and risks of the procedure include:
- Postoperative pain requiring device removal
- Urinary retention
- Urethral explosion
- Device infection
The Mini-Jupette sling is a relatively new procedure and is still being researched and improved. Patients should speak to their physician to find out if the Mini-Jupette sling could be an effective treatment option for them.