Orgasmic dysfunction after open radical prostatectomy: clinical correlates and prognostic factors

Area of Science:

• Urology
• Sexual Medicine
• Oncology

Background:

• Erectile function post-radical retropubic prostatectomy (RRP) is well-documented.
• Orgasmic function following RRP remains less understood.
• This study investigates changes in sexual and orgasmic function after RRP.

Purpose of the Study:

• To analyze sexual function, with a specific focus on orgasmic function, in men before and after undergoing RRP.
• To identify factors influencing orgasmic function post-RRP.

Main Methods:

• A cohort of 1,021 men undergoing RRP between 1977 and 2007 were interviewed.
• Standardized interviews assessed sexual interest, activity, erections, and orgasmic function pre- and post-RRP over 2 years.
• Patient age, surgical technique, pathological stage, and continence status were analyzed for predictive value.

Main Results:

• Pre-operatively, 90% of men reported normal orgasmic function; this decreased to 66.8% post-operatively.
• Orgasmic function preservation rates varied by surgical approach: 73.4% (bilateral nerve-sparing), 70.9% (unilateral nerve-sparing), and 54.0% (non-nerve sparing).
• Postoperative orgasm was present in 77.4% of men under 60 and 61.2% of men 60 and older (P < 0.0001).

Conclusions:

• Orgasmic function is generally preserved in the majority of men following RRP.
• Risk factors for post-RRP orgasmic dysfunction include older age (≥60 years), non-nerve sparing procedures, and severe urinary incontinence.