Premature ejaculation surgical treatment

Abstract

ABSTRACT Introduction Premature ejaculation (PE) occurs when a man experiences orgasm and expels semen soon after sexual activity and with minimal penile stimulation . it has also been called early ejaculation rapid ejaculation, rapid climax premature climax, and (historically) ejaculation praecox there is no uniform cut-off defining Premature, but a consensus of experts at the international Society for Sexual Medicine endorsed a definition including ejaculation which always or nearly always occurs Prior to or within about one minute [1] the international classification of Diseases (lcd-10) applies a cut-off of 15 seconds from the beginning of sexual intercourse [2] Materials and Methods The study took place at Hamad Specialized hospital and Alaa Clinic hospital between April 2011 and April 2016, 60 patients were included in this study, inclusion criteria was married heterosexual patients and age varies between 17 and 87 years old Surgical technique: All the patients received spinal anesthesia before Peno – scrotal incision and dissection of bulbspongiosus muscle bilaterally and cutting it completely,(Figures 1-7)then closure in layers followed by identification of frenulur delta (frenulur rough surface area) and excision of frenulur delta (elliptical). Suturing and dressing at the end of operation. In the patient with penile abscess and frenulur skin loss we apply split thickness graft. Intravaginal Ejaculation Latency Time (IELT) is calculated equal to the mean of 3 times done by the same way of sex practice for each individual pre and post-operative; evaluation of cases was done after 1,2,3,6 months then yearly. Results 58 patients improved dramatically after the 1st intercourse (3weeks after surgery) time of ejaculation continued to increase till the 3rd month after surgery then the time is constant. (Tables 1-3) All cases with time less than 2 Minutes (except 2) showed gradual increase in time during the first three months, most of them jumped to 4 – 5 minutes after 3weaks (1st intercourse) then 6 minutes after 2 months and 8 minutes after 3 months without change after that. 3 patients showed improvement directly, 1st patient was 2 minutes and changed to 20 minutes 2nd patient was 3 minutes and changed to 30 minutes (with 5years constant value in both patients) Two patients did not respond to surgery, in 1st patient time was about 20 second but they were not respond to Antidepressant and drugs that treat premature ejaculation and time was not exceed 20 second with drugs but after surgery time increase in 1st patient up to 7.40 minutes and second patient increased from 30 second up to 8.5 minutes with the effect of operation and drug together (clomipramine 50mg) Two patients complained from anejaculation up to around 90 minutes leading to interruption of intercourse. The condition improved after 40 days of operation and time increased from 10,12 minutes to 30, 35 minutes respectively. Conclusion Surgical technique to treat and improve ejaculation time, muscle cutting could be done The combined effect of cutting of bulbospongiosus and frenular delta excision is the best Disclosure Work supported by industry: no.