ABSTRACT
Selective dorsal neurotomy (SDN) is a surgical treatment for primary premature ejaculation (PE), but there is still no standard surgical procedure for selecting the branches of the dorsal penile nerves to be removed. We performed this study to explore the value of intraoperative neurophysiological monitoring (IONM) of the penile sensory-evoked potential (PSEP) for standard surgical procedures in SDN. One hundred and twenty primary PE patients undergoing SDN were selected as the PE group and 120 non-PE patients were selected as the normal group. The PSEP was monitored and compared between the two groups under both natural and general anesthesia (GA) states. In addition, patients in the PE group were randomly divided into the IONM group and the non-IONM group. During SDN surgery, PSEP parameters of the IONM group were recorded and analyzed. The differences in PE-related outcome measurements between the perioperative period and 3 months' postoperation were compared for the PE patients, and the differences in effectiveness and complications between the IONM group and the non-IONM group were compared. The results showed that the average latency of the PSEP in the PE group was shorter than that in the normal group under both natural and GA states (P < 0.001). Three months after surgery, the significant effective rates in the IONM and non-IONM groups were 63.6% and 34.0%, respectively (P < 0.01), and the difference in complications between the two groups was significant (P < 0.05). IONM might be useful in improving the short-term therapeutic effectiveness and reducing the complications of SDN.
Subject(s)
Male , Humans , Premature Ejaculation/surgery , Intraoperative Neurophysiological Monitoring/methods , Prospective Studies , Neurosurgical Procedures/methods , Penis/surgery , Retrospective StudiesABSTRACT
Selective dorsal penile neurotomy is a surgical method proposed for the treatment of primary premature ejaculation in recent years. In view of the inconsistency of surgical methods and the controversy of the operation itself, Large-scale, multi-center research evidence is needed for comprehensive evaluation. This article starts with the etiology of premature ejaculation, and reviews the anatomical basis, indications, contraindications, surgical methods, efficacy evaluation, complications and combined treatment methods of selective dorsal neurotomy.
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Objective To compare the efficacy and safety of paroxetine alone and combined with folic acid in patients complaining of premature ejaculation ,and measured the 5-hydroxyptamine(5-HT ) concentration in two groups before and after treatment and compared the differences .Methods 126 cases of PE were included from department of Urology of 363 Hospital of Chengdu .Subjects were randomly divided into 2 groups ,group A were given paroxetine hydrochloride 20 mg/d ,group B were given paroxetine hydrochloride 20 mg/d and fo-lic acid 0 .4 mg/d ,study duration was 8 weeks .Blood sample got from the candidates both in screening period and after 8 weeks of treatment .The efficiency after treatment was measured by IELT and PEP ,the plasma 5-HT level was measured too .SPSS16 .0 statistical analysis was used .Results After treatment ,IELT of group A and group B was improved from 1 .21 ,1 .18 min to 8 .04 ,9 .42 min .The improvement of average IELT in group B was significantly higher than that in group A ,the difference was statistically significant (P＜0 .05) ;The PEP score and 5-HT level in group B were significantly higher than that in group A ,the difference was statistically significant (P＜0 .05) .Conclusion Paroxetine combined with folic acid in the treatment of primary premature ejaculation has a significant effect ,compared to paroxetine alone .The average plasma level of 5-HT increased significantly ,and folic acid could assist paroxetine in elevating plasma levels of 5-HT and improving primary premature ejaculation symptoms .
ABSTRACT
<p><b>Objective</b>To evaluate the efficacy and safety of injection of botulinum-A toxin into the bulbospongiosus muscle in the treatment of primary premature ejaculation (PPE).</p><p><b>METHODS</b>According to the inclusion criteria, we randomly assigned 70 outpatients with PPE to a trial and a control group of equal number, the former injected with 100 U botulinum-A toxin at 10 U/ml and the latter with the same volume of saline into the bulbospongiosus muscle. Then, we obtained the intravaginal ejaculatory latency time (IELT), scores of the Premature Ejaculation Profile (PEP), Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD), and Hospital Anxiety and Depression Scale (HADS), and the incidence of adverse reactions between the two groups before and 4 weeks after treatment.</p><p><b>RESULTS</b>Complete data were obtained from 69 of the patients, 34 in the trial and 35 in the control group. The effectiveness rate was 47.06% (16/34) in the former but 0 in the latter. At 4 weeks after treatment, the patients of the trial group showed a significantly longer IELT than the controls and the baseline (［2.35 ± 1.83］ vs ［0.79 ± 0.21］ and ［0.74 ±+ 0.27］ min, P < 0.01) and the controls. The patients in the trial group, in comparison with those in the saline control group and the baseline, also exhibited significant improvement in the scores of PEP-ejaculation control (1.21 ± 1.04 vs 0.49 ± 0.56 and 0.47 ± 0.51, P < 0.05), PEP-sexual satisfaction (1.32 ± 1.01 vs 0.71 ± 0.57 and 0.79 ± 0.48, P < 0.05), PEP-PE-related distress (2.12 ± 1.01 vs 2.80 ± 0.68 and 2.76 ± 1.26, P < 0.05), and PEP-PE-induced difficult relationship with the partners (1.38 ± 0.70 vs 2.37 ± 0.55 and 2.12 ± 1.49, P < 0.05). The sexual satisfaction score of the female partners after treatment was markedly improved in the trial group as compared with the control group and the baseline (1.18 ± 1.00 vs 0.57 ± 0.50 and 0.62 ± 0.60, P < 0.05). There were no statistically significant differences in MSHQ-EjD and HADS scores between the two groups before and after treatment. Adverse reactions were observed in 6 cases (17.65%) in the trial group, including 4 cases of decreased erectile hardness (11.76%) and 2 cases of incomplete urination (5.88%), which occurred from the 3 to 4 days after injection, and those with decreased erectile hardness could complete sexual intercourse without any other treatment and recovered after 3 weeks.</p><p><b>CONCLUSIONS</b>Injection of botulinum-A toxin into the bulbospongiosus muscle can be used as an option for the treatment of PPE. Its clinical application value, however, needs to be verified by further studies with larger samples.</p>
ABSTRACT
<p><b>Objective</b>To investigate the feasibility and practicability of establishing an animal model of primary premature ejaculation using the ejaculation distribution theory.</p><p><b>METHODS</b>We induced behavioral estrus in 32 ovariectomized female SD rats by subcutaneous injection of 20 μg estradiol benzoate at 48 hours and 500 μg progesterone at 4 hours before mating them with 49 male rats once a week for six times. During the last three opulations, we observed the male animals for mounting latency (ML), intromission latency (IL), ejaculation latency (EL), postejaculation interval (PEI), mounting frequency (MF), intromission frequency (IF), intromission rate (IR), and ejaculation frequency (EF).</p><p><b>RESULTS</b>Finally, 22 of the male rats were included in this study. The mean EF>33 was deemed rapid ejaculation,EF<1 sluggish ejaculation, and EF 1.5－2.5 normal ejaculation. The EL was significantly shorter in the rapid ejaculation group than in the sluggish and normal ejaculation groups. The IF was the lowest in those with rapid ejaculation. No statistically significant differences were observed in the ML among the three groups of rats.</p><p><b>CONCLUSIONS</b>Based on the mean ejaculation frequency, the male rats with rapid ejaculation were easily screened, and this animal model may play an important role in exploring the mechanisms of primary premature ejaculation.</p>
Subject(s)
Animals , Female , Male , Rats , Disease Models, Animal , Ejaculation , Premature Ejaculation , Rats, Sprague-Dawley , Sexual Behavior, AnimalABSTRACT
Objective To investigate the relationship between concentration change of serum 5‐hydroxy tryptamine and clinical symptoms improvement in primary premature ejaculation with the treatment of paroxitine .Methods 81 cases of lifelong PE and an intra‐vaginal ejaculation latency time (IELT ) ≤60 s were included in this study .Subjects were divided into 2 groups according to the IELT ,group A (IELT≤30 s) and group B (30 s
ABSTRACT
Objective To evaluate the therapeutic effects and adverse events on treatment of primary premature ejaculation (PE) with paroxetine hydrochloride and/or tamsalosin .Methods 225 cases of healthy men ,a history of lifelong PE and an intravaginal e‐jaculation latency time(IELT) < 120 sec were included in this study .The patients were divided into three groups(with 75 cases in each group) .Group A were given paroxetine hydrochloride 20 mg/d for 8 weeks ;group B were given tamsalosin 0 .2 mg/d for 8 weeks ;group C were given paroxetine hydrochloride and tamsalosin for 8 weeks .The effects and adverse events were evaluated by the overall change and fold increase in average IELT and the mean change in all four measures of the premature ejaculation profile (PEP) .Results The reliable data from 198 patients were achieved .The mean IELT after treatment were significantly improved in all groups than that of before treatment (P<0 .05) .The mean IELT in group C was increased for 8 .15 min after treatment .The in‐creased folds of mean IELT in group C (8 .02 folds) was significantly higher than that in group B (1 .98 folds)and group A (6 .92 folds)(P<0 .01) .The mean PEP scores that include measures of perceived control over ejaculation ,satisfaction with sexual inter‐course ,ejaculation‐related personal distress ,ejaculation‐related interpersonal difficulty were significantly improved in all groups after treatment .The mean PEP scores in group C had more significant improvements than that in group A and B .The prevalence of ad‐verse events in group A ,B ,C were 10 cases(13 .3% ) ,2 cases(2 .6% ) and 9 cases(12 .0% ) ,respectively .Conclusion Paroxetine hydrochloride combined with tamsalosin lead to better therapeutic effects and could be a priority selection for the treatment of pri‐mary PE .