The dorsal penile nerve selective excision for primary premature ejaculation – the first premature ejaculation surgery method in China. The incidence of premature ejaculation is one of the common urological male diseases, accounting for 30%-50% of adult males, which seriously affects the quality of sexual life, causing great harm not only to the body and mind of patients, but also threatening the relationship between husband and wife and family harmony. The cause of premature ejaculation is thought to be due to psychosomatic factors, but recent research results show that there is a neuropathic organic lesion of premature ejaculation, i.e. penile head sensory hypersensitivity or penile head sensory nerve excitability, resulting in a low ejaculation threshold, making the ejaculation latency shorter and causing premature ejaculation. Clinically, premature ejaculation is classified as primary premature ejaculation: it refers to those whose ejaculation latency is always less than 2 minutes since the first sexual intercourse to the end. Secondary premature ejaculation: refers to men who had normal ejaculation latency in the past and then gradually developed a short ejaculation latency. The lack of effective clinical treatment for premature ejaculation, especially primary premature ejaculation, has long plagued urologists and male surgeons with premature ejaculation treatment. By reducing the sensitivity of the penis head and increasing the ejaculation threshold, we can prolong the ejaculation latency and improve the sexual life time to treat premature ejaculation.
[Principle of surgery].
The penile sensory pathway starts from the sensory apparatus in the penile skin, penile head, urethra and penile corpus cavernosum, and sends out nerve fibers to fuse to form the dorsal penile nerve bundle, joining other nerve fibers to become the internal pubic nerve, and then ascends to the spinal cord through the dorsal root of the sacral nerve, and after the receptors are activated, the pain, temperature and touch information is transmitted to the hypothalamus and cortical layer through the dorsal penile nerve, pubic nerve, spinal cord and spinal thalamus bundle for sensation. With contact stimulation, nerve impulses from the penile skin and the penile head are transmitted through the dorsal penile nerve to initiate and maintain reflex penile erection.
Effect evaluation]
After dorsal penile nerve selective excision, the sensitivity of the penile head can be reduced, the ejaculatory stimulation threshold can be increased, the ejaculatory latency (sexual life time) can be prolonged, and the quality of sexual life of patients can be improved. Generally, sexual life can be started 3~4 weeks after surgery, with good safety performance and an efficiency rate of about 90%. Patients have significantly prolonged sexual life and their ability to control ejaculation consciously is greatly enhanced.
【Risks of surgery and clinical analysis
1. The traditional view is that premature ejaculation is mostly due to psychological reasons, such as improper sexual awareness in childhood, sexual trauma, sexual guilt, lack of confidence in sexual life, etc. In recent years, many studies at home and abroad have shown that the excitability of the dorsal penile nerve in premature ejaculation patients, especially the excitability of the sensory nerve of the penile head, is higher than normal, so that the ejaculatory latency and ejaculatory reflex arc are shorter during sexual intercourse, and the ejaculatory stimulation threshold is low, which can easily induce premature ejaculation during sexual intercourse.
2, the penile sensory pathway starts from the penile skin, the penile head, the urethra and the sensory apparatus in the penile corpus cavernosum, sending out nerve fibers to fuse to form the dorsal penile nerve bundle, joining other nerve fibers to become the internal pubic nerve, and then ascending to the spinal cord through the dorsal root of the sacral nerve, and after the receptors are activated, the pain, temperature and tactile information is transmitted to the hypothalamus and the cortical layer through the dorsal penile nerve, the pubic nerve, the spinal cord and the spinal thalamus bundle for perception. With contact stimulation, nerve impulses from the penile skin and the penile head are transmitted through the dorsal penile nerve to initiate and maintain a reflex penile erection. Therefore, after selective penile dorsal nerve amputation, the sensitivity of the penile head can be reduced, the ejaculatory stimulation threshold can be increased, the ejaculatory latency can be prolonged, and the quality of sexual life of patients can be improved.
4.Usually the dorsal penile nerve is 2 branches, and we found through basic research that the number of dorsal penile nerve is
3.6 branches ± 1.2 branches. We found during the surgery that the number of primary premature ejaculation is as many as 8-9 nerves and even 13 nerves in some patients, which causes high sensitivity to sexual stimulation and premature ejaculation.
5.The surgery adopts circular incision, which can completely expose and remove all the dorsal penile nerves, then according to the theoretical basis, three dorsal penile nerves are preserved and closed with sheep intestine suture without removing the sutures.
6.The surgery will not lead to impotence or male infertility. Because the erectile function of men is formed by the filling and expansion of the penile corpus cavernosum and the normal function of venous occlusion, the surgery did not affect the blood flow to the penis. Because sperm is formed in the testicles and discharged through the reproductive ducts, the operation is an incision at the coronal groove and does not injure the testicles or the reproductive ducts, so it does not affect male fertility.
Indications for dorsal penile nerve selective excision
1, sexual erection of the penis continues to reach level IV hardness.
2, high sensitivity of the penile head.
3, the quality of sexual life seriously affect the relationship between husband and wife.
4.Voluntary abandonment of non-surgery.
[Entry criteria for primary premature ejaculation]
(I) Premature ejaculation occurs almost every time of sexual life.
(ii), Occurs almost every time when having sex with any sexual partner.
(iii) It has been present since the first sexual intercourse.
(iv).In the majority of cases, the duration of sexual intercourse is within 30~60sec.
(v), Difficulty in the ability to delay ejaculation, low or lack of ability to inhibit ejaculation of semen when ejaculation is imminent.
Advantages of [dorsal penile nerve selective excision]
1. High total efficiency and significantly improved quality of sexual life.
2. The surgical method is safe and reliable, with few complications.
3.The treatment cost is suitable.
4.No effect on sexual desire.
5.Good privacy.
6.No systemic adverse reactions.
7.No need for sexual partner participation, easy to accept.
8, reduce due to sexual behavior therapy may lead to prostate congestion or even the formation of chronic prostatitis.