Anatomic Basis and Clinical Effect of Selective Dorsal Neurectomy for Patients with Lifelong Premature Ejaculation: A Randomized Controlled Trial.

INTRODUCTION: Although guidelines from the American Urological Association and European Association of Urology do not consider surgical treatment for premature ejaculation (PE), the use of selective dorsal neurectomy (SDN) has increased for many years in Asian countries.

AIM: To evaluate anatomic basis and clinical effect of SDN in patients with PE in mainland China.

METHODS: All of the patients included in the study had redundant foreskin, and they were assigned to 2 groups: group 1, composed of 46 patients with redundant foreskin, and group 2, composed of 96 patients with redundant foreskin and PE. The patients in group 2 were further randomly classified into group 2a (n = 48) and group 2b (n = 48).

MAIN OUTCOME MEASURES: The number of dorsal penile nerve branches were compared among group 1, group 2a, and group 2b. Preoperative and postoperative intravaginal ejaculatory latency time (IELT), 5-item version of the International Index of Erectile Function, Premature Ejaculation Diagnostic Tool, and postoperative complications were compared between group 2a and group 2b.

RESULTS: The patients in group 2 had a greater number of dorsal penile nerve branches of 1-2-mm-diameter, ≥2-mm-diameter, and total branches than group 1. The postoperative IELT of group 2a (257.7 ± 205.7 seconds) was longer than that of group 2b (49.3 ± 26.1 seconds). Group 2a had more ejaculation controllability and lower Premature Ejaculation Diagnostic Tool scores than group 2b after the surgery (P < .001). We did not observe permanent numbness in glans, wound infection, or hematoma in any patients.

CLINICAL IMPLICATION: SDN is an effective treatment for lifelong PE patients who had poor response to medicine or refused oral medication.

STRENGTH & LIMITATIONS: This study has some strengths. First, the study made a comprehensive comparison based on both the numbers of dorsal penile nerve branches and the effect. Second, a randomized controlled trial design was used for the evaluation of SDN. It also possesses a limitation-we did not determine how many dorsal nerves should be selectively resected for each person to achieve optimal IELT prolongation.

CONCLUSION: The dorsal penile nerve branches of patients with lifelong PE are more and thicker than those without lifelong PE, and SDN is effective in improving lifelong PE by IELT prolongation and ejaculation controllability, with few postoperative complications. Liu Q, Li S, Zhang Y, et al. Anatomic Basis and Clinical Effect of Selective Dorsal Neurectomy for Patients with Lifelong Premature Ejaculation: A Randomized Controlled Trial. J Sex Med 2019;16:522-530.