Contemporary Practices in the Assessment and Management of Climacturia: Results from an International Survey.

Background: Climacturia is a distressing but underrecognized complication following prostate cancer treatment. Despite increasing awareness, its assessment and management remain heterogeneous in clinical practice. Objective: To evaluate current diagnostic and therapeutic practices for climacturia among expert urologists and to propose a preliminary, practice-based Climacturia Assessment Tool. Design setting and participants: A 34-item survey was distributed to members of the Trauma and Reconstructive Urology Working Party of the European Association of Urology (EAU) Young Academic Urologists (YAU) and the European Association of Urology Section of Genitourinary Reconstructive Surgeons (ESGURS). Fifty-one urologists and eight doctors in training completed the questionnaire. Descriptive statistics were used to summarize the findings. Outcome measurements and statistical analysis: Survey responses were summarized using medians (interquartile ranges [IQRs]) and frequencies. Results and limitations: Among the participants, 86% correctly defined climacturia, but only 59% routinely assessed it. Approaches to severity assessment were highly variable. Estimated prevalence ranged from 5% to 30%, depending on timing and association with stress urinary incontinence (SUI) or erectile dysfunction. Across 24 clinical scenarios, conservative strategies predominated in mild cases, male slings in moderate SUI-associated scenarios, artificial urinary sphincters in severe SUIs, and the Mini-Jupette procedure when penile prosthesis was required. Conclusions: Current assessment and management of climacturia vary substantially among participants. These findings highlight unmet needs in standardization and support further validation of structured assessment tools.