Neil Grafstein

1348 IMPACT OF MALE URETHRAL SLING PLACEMENT ON POST-PROSTATECTOMY CLIMACTURIA

INTRODUCTION AND OBJECTIVES: Radical prostatectomy (RP) is an effective treatment for localized prostate cancer, but can result in long term complications such as stress urinary incontinence and erectile dysfunction. Climacturia is a poorly characterized consequence of RP that can have adverse quality of life implications and has been cited to affect up to 93% of post RP patients. The aim of this study is to determine the impact of male urethral sling placement on postprostatectomy climacturia. METHODS: A retrospective review of all men who underwent urethral sling placement between 2007 and 2011 was generated. All patients were queried by telephone questionnaire that examined aspects of climacturia, including frequency, amount of urine loss, bother score of patient and partner, and coping mechanisms (Lee, et al), both before and after urethral sling placement. RESULTS: Thirty-three patients were eligible for analysis. Twenty patients answered the full questionnaire and comprise the study cohort. Pre operative average pad weight was 153 g (range 50-370). Mean follow-up was 18 months (range 3.1-37.8). Sixteen of 20 men (80%) were pad-free or minimally spotting on chart review at last follow-up. Fifteen of 20 men were not sexually active prior to sling placement. Eight were impotent, 1 was celibate and 6 were potent, but avoided sexual activity due to incontinence during intercourse. In total, there were 11 potent men, of which 10 acknowledged climacturia. All of the men and their partners (100%) found climacturia to be bothersome to varying degrees (see Figure). After sling placement, 9 of 10 men (90%) had improvement in bother score for climacturia (p 0.05). Six of 10 men (60%) had completely resolved climacturia, including 3 who avoided sexual activity due to leakage prior to sling placement. In three of the 4 patients who still had climaturia, it rarely occurred and the amount of urine loss was quantified as a few drops. CONCLUSIONS: Male urethral sling placement for post-prostatectomy climacturia has a positive effect, with 90% of the study group showing a benefit. Climacturia should be specifically inquired about in the post-prostatectomy period and if it results in sufficient bother to the patient, urethral sling placement as a treatment should be discussed.