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Neglected side effects after radical prostatectomy: a systematic review.

Anders Ullmann Frey1, Jens Sønksen, Mikkel Fode

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Summary

Radical prostatectomy (RP) can lead to common sexual side effects like orgasm-associated incontinence (OAI) and penile shortening (PS). While many side effects improve over time, predicting individual patient risk remains challenging.

Keywords:
ClimacturiaDysorgasmiaOrgasm-Associated PainPenile LengthRadical Prostatectomy

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Area of Science:

  • Urology
  • Sexual Medicine
  • Oncology

Background:

  • Radical prostatectomy (RP) is associated with several previously underrecognized sexual side effects.
  • These include orgasm-associated incontinence (OAI), urinary incontinence during sexual stimulation (UISS), altered orgasm perception, orgasm-associated pain (OAP), penile shortening (PS), and penile deformity.

Purpose of the Study:

  • To systematically review the existing literature on the incidence and characteristics of sexual side effects following radical prostatectomy (RP).

Main Methods:

  • A systematic literature search was conducted using Medline, Web of Science, and the Cochrane library.
  • The review followed PRISMA guidelines, with the protocol registered on PROSPERO (CRD42012003165).
  • Incidence rates of relevant side effects were the primary outcome measure.

Main Results:

  • 43 articles were included in the review.
  • OAI and UISS affect 20-93% of RP patients; previous transurethral resection of the prostate (TURP) is the only identified predictor.
  • Approximately 80% experience altered orgasmic function, often linked to erectile dysfunction. OAP affects 3-19%, with seminal vesicle sparing increasing risk. PS occurs in 15-68%, potentially mitigated by nerve sparing and preserved erectile function.
  • Most side effects show improvement over time.

Conclusions:

  • Sexual side effects are common after RP, but predicting individual patient risk is difficult.
  • Factors associated with increased risk include daytime incontinence, prior TURP, lack of nerve sparing, and erectile dysfunction.