Hello, I would like to learn about the neurotomy for premature ejaculation. Is it a safe and recommended procedure? Can it affect erections or penis size? Are patients happy? I am not from Russia, but I could be interested, so I ask these questions here, thank you very much for your time.

Victor

Dear Victor,

Premature ejaculation (PE) is characterized by ejaculation that occurs prior to or within a very short duration of the initiation of vaginal penetration (within one minute or less) or other relevant sexual stimulation, with no or little perceived control over ejaculation. The main reasons of PE are still unknown, but some data support biological and psychological hypotheses, including anxiety, penile hypersensitivity and 5-hydroxytryptamine receptor dysfunction.

According to European Association of Urology (EAU) guidelines there are several conservative treatment options of PE management: using control/delay ejaculation techniques, pharmacotherapy (a short-acting SSRI e.g. dapoxetine), topical anaesthetic agents, centrally-acting analgesic agent etc. Surgical PE treatment (e.g. selective dorsal neurectomy(SDN)) is an unconventional therapeutic option. Due to the possible risk of sexual function permanent loss guidelines do not recommend it. Nevertheless, the efficacy of surgical treatment has been evaluated in several Asian clinical trials. The goal of PE surgical treatment is to increase ejaculatory latency by reducing penile sensitivity. Asian urologists have reported that SDN gives a significant increase of intravaginal ejaculatory latency time and a satisfaction rate of 81.8%. Complications such as penile edema, glans pain, wound dehiscence and delayed ejaculation occurred in only 11.8% of cases. There is no evidence about penile loss after SDN in recent scientific publications. The efficacy of SDN has been demonstrated in other several studies, but despite the good outcomes they remain not recommended in urological guidelines, due to the rare risks of erectile dysfunction and penile sensory loss.

Here in Moscow urologists are used to apply surgical PE treatment (SDN) in severe cases when conservative treatment is not effective. But we usually warn our patients of all probable negative consequences of surgical PE treatment and the final decision is up to the patient.
I hope you will find this data usefull. If you require anyfurther information, feel free to contact us.

Best regards,
Dmitry O. Korolev
Urology consultant
Sechenov University

Клиника урологии Фронштейна

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