(076) Hyaluronic Acid Injection of Penis for Management of Premature Ejaculation: A Systematic Review with Single-Arm Meta-Analysis

Abstract

Abstract Introduction Premature ejaculation (PE) is the most prevalent male sexual dysfunction globally. Pharmacological treatments as the primary mainstay for PE therapy have drawbacks in systemic effect and possible recurrence after drug cessation. In the last few years, there has been a progressive use of hyaluronic acid (HA) injection in Andrology, including its use to prolong ejaculation latency time by increasing penile glans sensitivity. However, no meta-analysis on its efficacy and safety exists. Objective The study aimed to conduct a comprehensive systematic review and single-arm meta-analysis to identify the efficacy and safety of HA injection in the penis for treating PE. Methods A systematic search on PubMed, Scopus, and Embase databases were searched from inception to May 31, 2023, according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Risk of bias of included study were carried out based on Cochrane ROB2 and ROBINS-I tools. Intravaginal ejaculatory latency time (IELT) was considered the primary outcome, whereas satisfaction and complication rate were the secondary outcomes. Pooled rate and mean difference with matching 95% confidence level intervals (CIs) in the random effect model were applied in analysis using STATA 18.0 and RevMan 5.4. To ensure the impact of each study, a leave-one-out sensitivity analysis was performed. Results Of the 60 studies identified, three clinical trials and six observational studies with low and moderate risk of bias met the inclusion criteria. A total of 616 participants were eligible for meta-analysis. The results found that HA injection, with different techniques, can significantly increase IELT by 239.78 (95% CI 147.14 – 332.43), 202.76 (95% CI 121.86 – 283.66), 164.62 (95% CI 112.19 – 217.06), and 189.01 (95% CI 71.74 – 306.28) seconds at 1, 3, 6, and ≥12 months follow-up. Despite significant heterogeneity among the studies, the sensitivity analysis results were unaffected by the removal of any of the articles. As for safety, the most commonly reported complications were pain, ecchymosis, and papule formation with pooled incidence of 19% (95% CI: 15% – 24%), 8% (95% CI: 5% – 13%), and 5% (95% CI: 3% – 8%), respectively. The majority of adverse events were mild, temporary, and self-limited, although a single case of skin necrosis and vascular emboli had been reported. In addition, patients and their partners also reported increased satisfaction after HA injection. Conclusions HA injection in the penile can effectively prolong the ejaculation time by at least a year with tolerable adverse events. Nevertheless, the optimal injection technique, ideal patient candidate, and long-term outcome still need to be determined through additional well-designed trials. Disclosure No.