Progresses in pharmaceutical and surgical management of premature ejaculation / 中华医学杂志(英文版)

Objective@#Premature ejaculation (PE) is regarded as one of the most common male sexual dysfunctions. This review introduced several pharmaceutical and surgical methods for the management of PE. The definition, etiology, behavioral, and psychological therapy of PE were also discussed.@*Data sources@#"Premature," "ejaculation," or "sexual dysfuction" were used as the medical subject headings (MeSH) to obtain relevant articles before June 2019 on Pubmed, Google Scholar and CNKI. Most articles used were written in English and several Chinese articles were also cited.@*Study selection@#Full-text articles of retrospective/prospective/randomized controlled trials were analyzed. Animal experiments and letters were excluded.@*Results@#There are four PE sub-types: lifelong PE, acquired PE, natural variable PE, and subjective PE. Behavioral therapy, psychotherapy, medication, topical anesthetics, and surgery are currently used for the treatment of PE. However, all the above treatments have limitations. Therefore, novel ways should be investigated to more efficiently control PE.@*Conclusions@#The pharmaceutical therapy that is currently being used in clinical practice for the management of PE is still the main choice globally due to its good efficacy. Surgery may be a choice for patients who are resistant to medication. However, it should be performed cautiously.

Repair of fingertip defect with free second toe tibial flap anastomosed by the dorsal nerve of the toe / 中华整形外科杂志

Objective@#To report the operation methods and clinical effects of repairing finger tip defect with the free tibial dorsal nerve flap of the second toe.@*Methods@#13 patients with finger tip defects were repaired by the tibial dorsal nerve flap of the second toe. The area of finger tip defect was 2.5 cm×1.5 cm-1.3 cm×1.0 cm, and the area of cutting flap was 2.7 cm×1.7 cm-1.5 cm×1.1 cm. All donor site defects on the second toe were covered with full-thickness skin graft.@*Results@#There were 13 cases in this group, and all the flaps and skin grafts were survived. Postoperative follow-up ranged from 6 to 18 months, with an average of 13 months. The appearance of the fingers was satisfied and the sensory recovery was good. Two-point discrimination of the flaps returned to 7-13 mm, with an average of 9 mm. According to the total active move(TAM)scale, results were excellent in 11 fingers, good in 1 finger, and fair in 1 finger. The donor site skin graft was well healed, the second toe pulp was full, and the two-point discrimination of the toe pulps were 6-10 mm, with an average of 8 mm.@*Conclusions@#Compared to the traditional method of repairing finger tip defect with the tibial inherent nerve flap of the second toe, our new method can reduce the damage to the donor site, and we can repair finger tip defect as well as the traditional one at the same time. So it was a better operative method to repair finger tip defect with the tibial dorsal nerve flap of the second toe.

Morfometría de los nervios sensitivos del dorso del pie en el hombre / Morphometry of the sensitive nerves of the dorsum of the foot in man

La inervación cutánea del dorso del pie, está dada por los nervios fibular superficial (NFS), ramo del nervio fibular común; sus ramos, cutáneo dorsal medial (NCDM) y cutáneo dorsal intermedio (NCDI), así como también por el cutáneo dorsal lateral (NCDL), ramo del nervio sural y el ramo cutáneo del nervio fibular profundo (RCNFP). Estos, pueden ser lesionados en su proximidad con estructuras óseas en su ubicación más superficial, en intervenciones quirúrgicas, por compresión, tracción o fricción crónica. Realizamos un estudio morfométrico y estereológico en 5 muestras de NFS, NCDM, NCDI, NCDL y RCNFP en cadáveres de individuos adultos, masculinos. Se obtuvieron secciones transversales de cada uno de los nervios después de su origen, a nivel del tercio distal de la pierna y del dorso del pie. Realizamos cortes de 4 um de grosor, teñidos con H.E. El promedio de fascículos fue: NFS 12 (D.E. 2,39); NCDM 8 (D.E. 4,82); NCDI 5 (D.E. 1,67); NCDL 7 (D.E. 3,27) y RCNFP 4 (D.E. 1,30). El promedio de fibras para el NFS, NCDM, NCDI, NCDL y RCNFP fue: 14.080, 7.636, 4.602, 3.732 y 2.941, respectivamente. El área promedio del NFS, NCDM, NCDI, NCDL y RCNFP fue: 1,54 mm2 (D. E. 0,22), 0,82 mm2 (D. E. 0,31), 0,54 mm2 (D. E. 0,23), 0,42 mm2 (D.E. 0,19) y 0,32 mm2 (D.E. 0,13) respectivamente. Con este estudio, se espera contribuir al conocimiento morfológico respecto a los factores que podrían influir en el grado de recuperación de lesiones nerviosas, importantes en la clínica y en las técnicas de microcirugía.

The cutaneous innervation on the dorsum of the foot, is given by the superficial fibular nerves (SFN) a branch of the common fibular nerve: its branches, and cutaneous medial dorsal (MDCn) and cutaneous intermediate dorsal (IDCn). Also, the cutaneous lateral dorsal (LDCn) branch of the sural nerve and cutaneous branch of the deep fibular nerve (DFCBn). These can be injured in their proximity with osseous structures in their most superficial location, in surgical procedures, by compression, traction or chronic friction. We carried out a morphometric and stereological study in 5 samples of SFN, MDCn, IDCn, LDCn and DFCBn in cadavers of adult male individuals. Transverse sections of each of the nerves were obtained following its origin, at the level of the distal third of the leg and dorsum of the foot. We realized slices of 4 um thick, stained with H.E. The average of the fascicles was: SFN 12 (D. E. 2.39); MDCn 8 (D. E. 4.82); IDCn 5 (D. E. 1.67); LDCn 7 (D. E. 3.27) and DFCBn 4 (D. E. 1.30). The average of fibers for SFN, MDCn, IDCn, LDCn, and DFCBn was: 14.080, 7.636, 4.602, 3.732 y 2.941 respectively. Average area of SFN, MDCn, IDCn, LDCn, and DFCBn was 1.54 mm2 (D. E. 0.22), 0.82 mm2 (D. E. 0.31), 0.54 mm2 (D. E. 0.23), 0.42 mm2 (D. E. 0.19) y 0.32 mm2 (D. E. 0.13) respectively. With this study we hope to contribute to morphological information in reference to factors that could influence in the degree of recovery of nerve lesions, important in clinic as well as microsurgery techniques.

The Influence on Neural Conduction after Alcohol Injection into Penile Dorsal Nerve of Rats / 대한비뇨기과학회지

PURPOSE: Premature ejaculation is the most common male sexual disorder, affecting perhaps as many as 75% of men, but its cause has not been well established. The objective of this study is to evaluate whether alcohol injection on the dorsal aspect of the penis can induce a desensitization of penile sensory nerve fiber in rats. MATERIALS AND METHODS: Forty-four male Sprague-Dawley rats were divided into 4 groups. Group I of 4 rats, the control group, did not undergo any procedure. Group II of 8 rats, received only an alcohol injection without electrical stimulation. In group III of 4 rats, only electrical stimulation was performed without alcohol injection. In group IV of 28 rats, all rats received an alcohol injection on the dorsal aspect of the penis, and groups of four rats were sacrificed after electrical stimulation on the glans penis at 1, 2, 4, 7, 10, 14, and 21 days after alcohol injection. Spinal cords were sectioned and processed for immunohistochemical staining for c-Fos protein. RESULTS: No c-Fos protein was detected in the normal control group, and either none or few c-Fos protein positive neurons were seen in the alcohol injection only group. The number of c-Fos protein positive neurons in the electrical stimulation only group was 30.25+/-3.53 cells/section. Four days after alcohol injection, the level of c-Fos protein positive neurons was reduced significantly compared with the control group (p<0.05), and was very close to the control group at 10 days after alcohol injection. CONCLUSIONS: Our study demonstrates that alcohol injection in the dorsal aspect of the penis reduces c-Fos protein positive neurons in the spinal cord segment through desensitization of penile sensory nerve fibers.

Characteristics of Bulbocavernous Reflex Latency Test and Dorsal Nerve Somatosensory Evoked Potential Test in Patients with Premature Ejaculation

BACKGROUND: Though its cause has not been well established, premature ejaculation is the most prevalent form of male sexual dysfunction. Some recent studies suggest that penile hypersensitivity and hyperexcitability, earlier excitation of the sacral reflex arc, and abnormality with peripheral and central afferent nerve conduction pathways, are related to premature ejaculation. METHODS: The bulbocavernous reflex latency (BCRL) test and dorsal nerve somatosensory evoked potential (DNSEP) test were done in 15 normal subjects (mean age: 38.2 years) and 30 premature ejaculation patients (mean age: 40.2 years) without history of neurological disorders nor history of medication which influences the nervous system. RESULTS: The mean latency of BCR was shortened significantly in patients with premature ejaculation (33.1+/-3.08 msec) than in the control group (37.2+/-3.95 msec)(P<0.01). However, there were no significant differences in latency and amplitude of DNSEP tests between the two groups. CONCLUSIONS: Based on our results, the earlier excitation of the sacral reflex arc might be related to premature ejaculation. (J Korean Neurol Assoc 19(5):494~497, 2001)

The Partial Neurectomy of the Dorsal Nerve of the Penis for Patient with Premature Ejaculation / 대한남성과학회지

PURPOSE: A clinical review was performed to evaluate the effectiveness of the partial neurectomy of the dorsal nerve of the penis on the treatment of premature ejaculation. PATIENTS AND METHODS: The study was made on 143 patients with premature ejaculation (mean age 38 years; range 22~53 years) who underwent the partial neurectomy of the dorsal nerve of the penis from January 1997 to September 1999. All patients were evaluated by change on pre- and post-operative ejaculatory latency and biothesiometry, postoperative satisfaction, management on unsatisfactory patients and postoperative complication. RESULTS: Pre- and post-operative vibration perception threshold of glans penis on biothesiometry was significantly decreased from mean 2~3 mA (range 1~6 mA) to 8~10 mA (range 3~15 mA) (p<0.01). Change on pre- and post-operative ejaculatory latency was prolonged from mean 1~3 minutes (55.2%) to 5~10 minutes (47.6%)(p<0.01). The postoperative results were satisfactory in 117 cases (81.8%). At follow-up 2 to 34 months postoperatively, 17 cases (11.8%) were complicated by glans pain, discomfort(7 cases), penile edema (6 cases), wound dehiscence(3 cases), and delayed ejaculation (1 case). CONCLUSION: The partial neurectomy of the dorsal nerve of the penis is an effective treatment in the comprehensive management of the premature ejaculation with glans hypersensitivity, for good results, a simple operative technique and a few postoperative complication. However, it must be followed up for long-term effectiveness and its complication.

Neurilemmoma in Cervical Dorsal Nerve Root: A case report

Neurilemmoma is benign neurogenic tumor which arise from the sheath of Schwann, its incidence on cervical nerve root are very rare. The patient with cervical root involvement presents pain or sensory disturbances of the upper extremity, neck, and/or chest wall. Usually, symptoms caused by pressure on the sensory and motor nerve roots with tumor mass. We report a patient with C8 dorsal nerve root neurilemmoma, with the brief review of literature.

Efficacy of Oral Pharmacotherapy according to Results of Biothesiometry, BCRL and DNSEP in Patients with Premature Ejaculation / 대한비뇨기과학회지

PURPOSE: To determine whether biothesiometry, bulbocavernous reflex latency(BCRL), and dorsal nerve somatosensory evoked potential(DNSEP) test could predict efficacy of tricyclic antidepressant(TCA) or selective serotonin reuptake inhibitor(SSRI) to prolong the ejaculatory latency in premature ejaculation. MATERIALS AND METHODS: A total of 33 patients with pramature ejaculation(mean age: 44 years) completed the entire study, Patients took each of clomipramine(50mg), sertraline(1 00mg), and fluoxetine(40mg) consecutively during a 4-week period per each agent. We obtained increased intravaginal ejaculatory latency by the most effective drug among 3 drugs. We analyzed correlations of the increased intravaginal ejaculatory latency with vibration threshold of penile shaft and glans, BCRL, and latency and amplitude of DNSEP. RESULTS: According to Pearson's correlation analysis, there was no correlation of intravaginal ejaculatory latency with vibration threshold of penile shaft and glans, BCRL, and latency and amplitude of DNSEP(all p> 0.05). There was no difference in intravaginal ejaculatory latency between the groups of high and low vibration threshold, long and short BCRL, long and short latency of DNSEP, and large and small amplitude at cerebral cortex on DNSEP test(all p> 0.05). CONCLUSIONS: It seems that biothesiometry, BCRL, and DNSEP test can not predict the efficacy of tricyclic antidepressant or selective serotonin reuptake inhibitor to prolong the ejaculatory latency in premature ejaculation.

Comparison of Nerve Conduction in the Dorsal Nerve of Penis before and after Erection

OBJECTIVE: To explore the diagnostic value of the nerve conduction study in the dorsal nerve of penis before and after erection. METHOD: Nineteen subjects with a confirmed psychogenic impotence were studied for the superficial peroneal and sural sensory nerve conductions, bulbocavernous reflexes (BCR), tibial and pudendal somatosensory evoked potentials (SEP), and conduction studies of the dorsal nerve of penis. Sixteen subjects with normal findings had repeat studies after an injection of Prostaglandin E1. RESULTS: Erection helped to obtain a dorsal penile sensory potentials in 18.8% of the 16 subjects. The mean conduction velocity of the dorsal nerve of penis increased significantly from 33.8+/-9.3 m/sec to 48.4+/-12.8 m/sec. The mean sensory amplitude of the dorsal nerve of penis increased significantly from 1.7+/-1.0 microvolt to 2.8+/-1.4 microvolt. There was no significant difference in the BCR latency and the pudendal SEP (latency and amplitude) before and after erection. CONCLUSION: Erection helps to obtain the sensory potentials of the dorsal nerve of penis when it is technically difficult to obtain and increases the conduction velocity as well as amplitude of the dorsal nerve of penis. However it does not affect the BCR latency and pudendal SEP.

The Value of Bulbocavernosus Reflex Latency and Dorsal Nerve Somatosensory Evoked Potential in Diagnosis of Neurogenic Impotence / 대한비뇨기과학회지

Bulbocavernosus reflex latency (BCRL)and dorsal nerve somatosensory evoked potential (DNSEP)are used widely to diagnose underlying neurogenic disorders. Because these methods evaluate somatosensory nerve system and neurophysiology of the erectile process has not yet been satisfactorily clarified, it could be worthwhile to investigate the validity of these two. The BCRL and DNSEP were recorded in 89 subjects and 18 had abnormal results. Out of 18 patients, 8 and 16 had abnormal BCRL and DNSEP, respectively. Three of 8 patients with abnormal BCRL and six of 16 with abnormal DNSEP were diagnosed psychogenic impotence as confirmed by audiovisual stimulation-penogram and nocturnal penile monitoring. Our study suggests that these methods may not be conformable to establish the diagnosis of neurogenic erectile failure and to use screening test for underlying neurogenic disorders.