Micrisurgical penile denervation (Selective Neurotomy) for treatment of severe life long premature ejaculation
1: Kharkiv National Medical University, Ukraine
Introduction: Premature ejaculation (PE) is a common problem for sexually active men. Traditionally for it treatment sexologists use SSRI on-demand or long-term. But in some cases this medicines are not effective or have some side effects. That is why we decide to investigate effectiveness, safety and long-term results of microsurgical denervation of penis glance – selective neurotomy (SNT).
Methods: During 2007-2017 years on the base of Andrological department of Kharkiv Regional Clinical Center of Urology and Nephrology 843 patients with PE were exanimated and treated. For this part of investigation we picked out 152 patients with severe (Intravaginal Ejaculation Latency Time (IELT) less than 60 sec) primary PE without neurological factors (anxiety, depression, etc.). There were exclude patients with prostatitis. All patients in this group have positive lidocaine test (increasing IVLT more than 2 time after using condoms or sprays with lidocaine or articaine). Biotesiometry showed sufficient increase of glance sensitivity up to 4 mV instead 7-10mV. Most of these patients were unsatisfied previous treatment with SSRI. Dapoxetine on-demand, Fluoxetine, Sertraline, Paroxetine for long-term use came to insufficient increasing of IVLT or side effects of medicines. These patients were undertaken microsurgical denervation of penile glance using microscope with 10 time enlargement. After circumcision we cut 50-80% branches of penile nerve in Bach fascia (more often 6 from 9 branches). Throw 3 weeks patients restart their sexual intercourses. We investigate sensitivity of penile glace, IELT and sexual satisfaction throw 1 and 6 months after surgery.
Results: The average IELT these patients before SNT consist 47.4+4.3 sec. All patients feel reduce of sensitive penile gland throw one month (by their sexual feeling and by results of biothesiometry) after surgery. 149 from 152 patients feel enough reduce of sensitivity of penile glance for prolonged IELT throw 6 month. 2 patients were re-operated and cut some more branches. 147 from 152 patients (96.7%) were satisfied their IELT and their sexual life. Average IELT after surgery was 6 min 57 sec+ 36 sec.
Conclusion: Selective neurotomy is safe, profitable and high effective method treatment of PE and may prove to be a last resort for traditional treatment when patients have severe side effects, pharmacological ineffectiveness and want more permanent solution for premature ejaculation.
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