Dorsal Penile Nerve Cutting Dorsal Penile Nerve Cutting is a kind of surgical way to treat premature ejaculation in recent years. Cutting off the dorsal penile nerve can delay ejaculation by reducing the sensitivity of the glans. Scholars both at home and abroad have reported the method and effect of dorsal penile nerve cutting in the treatment of premature ejaculation, but there are many scholars with negative attitude. Here, we analyze and summarize the current clinical data by understanding the origin and development of dorsal penile neurotomy for the treatment of premature ejaculation, to clarify whether dorsal penile neurotomy for the treatment of premature ejaculation is worth advocating or promoting. In 2001, a supplement to the International Journal of Impotence Research reported on the experience of a Brazilian research institute in treating PE with 409 cases of dorsal penile neurotomy in ten years. This report was one of the most frequently cited papers on the subject, and in 2004, the International Society For Sexual Medicine Mail (ISSM Mail) featured an intense discussion of dorsal penile neurotomy for the treatment of PE by a number of experts. Dr. Kevan Wylie from the United Kingdom began by asking if there had been any new developments or experiences with dorsal penile neurotomy since Romero and Rebello’s paper in 1994. The opponents argued that the treatment of PE by dorsal penile neurotomy was still experimental at that time, and that there had been no formal publication on the treatment of PE by dorsal penile neurotomy in a formal journal since 1966 (2004), and that subjects might be at risk of serious complications, including the loss of sensation and the inability to ejaculate that had already been reported. In 2010, the European Association of Urology (EAU) published the latest guidelines for the diagnosis and treatment of male sexual dysfunction, which added the treatment of premature ejaculation. The treatment of PE is divided into two categories, psychological behavioral treatment and drug treatment, the latter includes local topical medication and oral medication, and the treatment of premature ejaculation by dorsal penile neurotomy is not included in the guideline. From the current situation, there is no essential progress in the clinical research on dorsal penile neurotomy for PE: dorsal penile neurotomy for premature ejaculation is still in the clinical experiment stage; there is no alternative to surgical treatment for premature ejaculation at present. The treatment of premature ejaculation by dorsal penile neurotomy is currently in the research stage, and its long-term efficacy and long-term complications are unknown, as are the advantages and disadvantages of non-surgical treatment of premature ejaculation. A randomized controlled design with a large sample is needed to clarify the long-term effects and complications of this surgical procedure for premature ejaculation and the difference in effects between it and non-surgical treatments before it can be promoted in the clinic. Penile lengthening Due to the increase of people’s attention to the genitals, many male plastic surgery procedures have emerged, the most representative of which is penile lengthening. The common surgical methods of penile lengthening are: 1. abdominal pubic bone liposuction; 2. V-Y shaping penile lengthening surgery (the most common); 3. Z-type, M-type incision penile lengthening surgery. Common complications include: infection; hematoma; flap necrosis; prepuce edema; penile root scarring; sexual dysfunction; altered penile stability, decreased erection angle; no change in penile length after erection; penile retraction. According to domestic reports and literature, after penile lengthening surgery, patients are able to lengthen their penises by 5-6cm, and the degree of patient satisfaction is generally high. According to the Department of Plastic and Reconstructive Surgery of the Southwest Hospital of the Third Military Medical University, from January 1993 to December 2007, 130 patients with congenital penile hypospadias were treated with conventional and modified penile lengthening surgery, with the conventional group lengthening by 4.9 ± 1.4 cm and the modified group lengthening by 5.0 ± 1.5 cm, and the difference between the two groups was not statistically significant (P > 0.05). The self-assessed satisfaction rate of patients in the conventional group and the control group was 95% and 98%, respectively. Beijing Shuguang Men’s Hospital Reproductive Plastic Surgery Department adopted the subpubic area V-Y shaping penile lengthening surgery to treat 85 cases of penile hypospadias, and the natural length of the penis could be extended by 3-6cm after the surgery, and there was no obvious retraction of the penis in the follow-up period of 2-3 months, and most of the patients were satisfied with the results of the surgery. In 27 cases of V-shaped incision penile lengthening performed in Modern Men’s Hospital in Qiqihar City, Heilongjiang Province, 24 patients (89%) were satisfied with the length of the penis after surgery, and 18 patients (67%) were satisfied with their sexual life. According to foreign literature, after penile lengthening surgery, the penile length could only be extended by 1-3 cm, and there were many complications, and the degree of patient satisfaction was low.Li et al. carried out a follow-up of 27 patients with an average age of 39 years for an average of 16 months, and the average penile length was extended by 0.9-1.3 cm, and the degree of satisfaction was only 27%.Klein carried out a follow-up of 58 patients with an average age of 39.3 years for an average of 12.2 months, and the average penile length was extended by 0.9-1.3 cm. With a mean follow-up of 12.2 months, the patients’ penises lengthened by 3 cm in the flaccid state and only 0.75 cm in the erect state, with 69% of the patients failing to achieve a satisfactory length, and 62% of the patients expressing dissatisfaction with post-surgical erectile complications. There was also a survey on various surgical methods of penile lengthening surgery: 42 of the patients who had their penile suspensory ligament interrupted had their penises lengthened by 1.3-0.9cm, and the patient satisfaction survey was 35%. In 27 patients who had silicone cushioning device inserted, the length of penis was extended by 0.7-1.0cm, and the patient satisfaction survey was 36%, and in 10 patients who had VY plasty combined with silicone cushioning device surgery, the length of penis was extended by 0.7-0.8cm, and the patient satisfaction survey was 30%. Comparison of domestic and foreign follow-up data can be found, domestic and foreign patients with penile extension length and patient satisfaction is extremely large differences, the domestic operation patients generally extend the length of the penis 5-6cm, patient satisfaction is very high. The penile length of patients who underwent surgery in China was generally extended by 5-6cm, and the degree of patient satisfaction was very high. Caused such a big difference, perhaps the national physical differences, perhaps more mature domestic surgical methods and so on. The reason is worth our deep thought. It is even more important to warn our doctors that they need to be careful when performing surgery on such patients. The choice of varicocele surgery The diagnosis and treatment of varicocele has always been the focus of debate among urologists. Clinical treatment of varicocele has a wide range of surgical procedures, including low-level transmicroscopic spermatic vein ligation, intra-inguinal spermatic vein ligation, retroperitoneal ligation, laparoscopic spermatic vein ligation, retroperitoneal laparoscopic spermatic vein ligation, spermatic vein interventional embolization, and diversion, which are so many surgical procedures that it gives the patient and the surgeon quite a headache to choose. Now let’s discuss the advantages of various surgical procedures. Spermatocele surgery is categorized into unilateral and bilateral, and when dealing with bilateral varicocele, laparoscopic surgery shows obvious advantages over other surgical procedures both in terms of surgeon’s operation as well as minimally invasive concepts. Gu Hai Bin et al. from Sun Yat-sen University gave 153 patients an average group and performed laparoscopic varicocele ligation, inguinal varicocele ligation, and retroperitoneal high dissection respectively with a 12-month follow-up, and concluded that in the management of bilateral varicocele, laparoscopic varicocele ligation had a significant advantage over inguinal varicocele ligation and retroperitoneal high dissection. In the management of unilateral varicocele, microsurgery, which has emerged in recent years, has shown significant advantages. muslimov et al. performed microsurgical varicocele ligation in 129 patients, and laparoscopic varicocele ligation in 167 patients, with 13-60 months of follow-up, and concluded that microsurgical varicocele ligation was much less common than laparoscopic varicocele ligation in terms of complication and recurrence rates. vein ligation. Laparoscopy has obvious advantages in the treatment of bilateral varicocele, but it does not have high advantages in the treatment of unilateral spermatic vein, mainly in the following aspects: general anesthesia is required, which has a greater impact on the body, the instrument enters into the abdominal cavity, which has the risk of damaging the bladder and the intestinal canal, it requires special instruments, which is expensive and difficult to be carried out in the grassroots hospitals, and the metal foreign body is retained in the body. Since this kind of surgery is mainly concentrated in the grassroots level, it is unlikely that all the grassroots hospitals will carry out laparoscopic surgery and microsurgery. Therefore, it is still the main choice of open surgery, in which the inguinal canal spermatic vein ligation ligation site vein branches ligation is difficult to completely recurrence rate is high, and separation of the levator muscle easy to damage the levator muscle artery and the vas deferens, easy to damage the testicular artery is very easy to cause testicular atrophy, at present, except for the use of a very small number of grass-roots hospitals. Retroperitoneal small incision spermatic vein ligation has been the main method of treatment, the operation is simple surgical incision is small on the muscle blunt separation of trauma, ligation position in the inner ring above the mouth of the spermatic vein thick branch less arterial pulsation separation of blood vessels is easy to be able to get out of bed early after the operation to recover quickly, the cost of low more suitable for the conditions of China can be widely carried out in the grassroots hospitals. There are many ways to perform varicocele surgery, but overall it’s a blossoming situation. Doctors should choose the appropriate surgical method according to the patient’s condition, the hospital’s equipment and their own experience.