(030) Risk of Climacturia After Laser Enucleation of the Prostate for Benign Prostatic Obstruction

Introduction Anatomical endoscopic laser enucleation of the prostate (AEEP) is considered a first-line surgical treatment for benign prostatic obstruction (BPO) and is associated with a high rate of retrograde ejaculation, with possible negative impacts on orgasmic function. Similarly, patients treated with AEEP may experience transitory urinary incontinence (UI). Climacturia is defined as orgasm-associated UI and has been extensively reported after radical prostatectomy in association with UI. Objective The aim of this study was to investigate the prevalence and risk of climacturia in patients treated with AEEP for BPO. Methods We analyzed data from a prospectively maintained database including 202 consecutive patients treated at a single center with either holmium or thulium laser AEEP for BPO by three experienced surgeons. Preoperative and perioperative clinical and functional data, including the International Prostate Symptom Score (IPSS) and Sexual Encounter Profile (SEP) 2-3 questionnaire, were collected. All patients were reassessed at regular follow-up visits after surgery. The prevalence of postoperative climacturia was assessed with a dedicated questionnaire. Kaplan-Meier analysis was used to estimate the risk of UI over time. A landmark analysis was used to assess preoperative predictors of reporting climacturia within 3 months after surgery. Results Overall, 75 (37%) and 127 (63%) patients were treated with HoLEP and ThuLEP, respectively. Median (IQR) age was 71 (65, 75) years with a body mass index (BMI) of 22.4 (20.6, 25.8). Patients had a high median prostate volume [94 (65, 113) cc] with a median PSA of 3.3 (1.4, 6.9) ng/mL and an IPSS of 20 (11, 25). A total of 118 (58%) patients were sexually active with normal erection according to SEP 2-3 questions. At 3 months after surgery, estimated urinary continence recovery was 93% (95% CI: 80%, 99%). Climacturia was reported by 16% (N=33) of cases at 3 months after surgery, with 46% (N=92) of patients reporting being sexually active after surgery. At logistic regression analysis, prostate volume (PV) emerged as the only preoperative predictor of climacturia (OR: 1.01; 95% CI: 1.00, 1.02; p=0.01). The adjusted risk of climacturia for a patient with a PV of 40 cc was 9% (95% CI: 2–15%) compared to 22% (95% CI: 14–30%) for one with a PV of 100 cc (Figure 1). Of note, all patients recovered from climacturia at 12 months post- treatment. Conclusions This is the first study reporting the risk of climacturia after AEEP. Patients should be counseled regarding a non-negligible risk of transient climacturia after surgery, which appears higher for patients with larger prostate volumes. Disclosure No