The Relationship and Psychosocial Impact of Arousal Incontinence After Radical Prostatectomy

Carolyn A Salter, Phil Vu Bach, Darren Katz, Elizabeth Schofield, Christian J Nelson, John P Mulhall
Journal of Sexual Medicine 2019 November 14

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 2019;XX:XXX-XXX.

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