Objective To investigate the safety and efficacy of selective dorsal neurectomy(SDN)in the treatment of primary premature ejaculation(PPE).Methods The clinical data of 47 patients with PPE were retrospectively analyzed from December 2016 to December 2020.All patients were consistent with the clinical features of PPE.The age was(31.4±5.7)years old,the average duration of disease was(9.6± 5.1)years,there were 29 married cases(65.9％)and 15 unmarried cases(34.1％),IIEF-5 score was(23.6±1.2),PEDT score was(15.2±2.7),ejaculation control ability score was(10.1±1.5),sexual intercourse satisfaction about patients was(2.3±1.7),sexual intercourse satisfaction about sexual partners was(2.3±1.3),19 cases were grade Ⅲ hardness and 28 cases were grade Ⅳ hardness for NPT,and IELT was(0.9±0.5)minute.These patients underwent SDN,and the surgeon made a circular incision at 0.6-0.8cm from the coronal sulcus.Then,the surgeon cut the skin and subcutaneous tissue layer by layer and separated the penile fascia tissue at a distance of about 0.8-1.5 cm from the coronal sulcus,and the dorsal penile nerve could be seen above the anatomical level.Centering on the 12 o'clock in the middle of the dorsal side of the penis,the surgeon separator forceps to reveal the dorsal penile nerve by separating both sides,reaching the urethral corpus cavernosum ventrally to the penis,and used silk thread to gently lift.Depending on the patient's specific condition,one nerve at each of the 3,9,and 12 o'clock of the penile head was preserved.In principle,approx.3-4 dorsal penile nerves were preserved,the rest of the dorsal penile nerves were severed and a length of 3-4cm was removed.If the retained dorsal penile nerve was＞1.5 mm in transverse diameter,the surgeon continued to separate dorsal penile nerves distally until approaching the head of the penis.The total number and number of retained dorsal penile nerves were recorded.IELT,ejaculation control ability score,sexual intercourse satisfaction score,and postoperative complications were followed up at 3,6,12,and 24 months after the operation.Results All 47 cases of surgery were completed.The total number of dorsal penile nerves during the operation was 14 branches in 1 case,13 in 1,12 in 6,11 in 5,10 in 8,9 in 20,8 in 5,and 6 in 1,with an average number of dorsal penile nerves of(9.8±1.6).Forty-four patients were followed up,and 3 patients were lost to follow-up.The follow-up time was(35.0±10.2)months.The average IELT at 3,6,12,and 24 months after the operation was(3.8±2.1)min,(4.1±2.3)min,(4.8±2.4)min,(4.2±2.3)min,which was significantly different(P＜0.05).The ejaculation control ability after the operation was(5.9±2.9)scores,(6.7±2.9)scores,(4.7±2.7)scores,(6.7±3.0)scores,which was significantly different(P＜0.05).The sexual intercourse satisfaction of patients was(6.4±3.3)scores,(6.8±3.6)scores,(8.1±3.6)scores,(6.8±3.5)scores,which was significantly different(P＜0.05).The sexual intercourse satisfaction of sexual partners was(5.8±2.9)scores,(6.7±3.3)scores,(8.6±3.5)scores,(6.7±3.5)scores,which was significantly different(P＜0.05).There were 36 cases(81.8％),37 cases(84.1％),39 cases(88.6％)and 38 cases(86.4％)with effective operation at 3,6,12 and 24 months after the operation,respectively.None of the 44 cases had complications such as erectile dysfunction or abnormal erection.Conclusions SDN in the treatment of PPE can effectively improve the symptoms of premature ejaculation and improve the quality of sexual life.The operation is safe and feasible,with an ideal effect and fewer complications.It is a reliable choice for patients with PPE who cannot obtain satisfactory curative effects by non-surgical therapy or who voluntarily give up non-surgical therapy.
维普
万方数据
