The techniques, efficacy and safety of penile glans augmentation using hyaluronic acid for the treatment of premature ejaculation: a systematic review and meta-analysis

Abstract

BackgroundPremature ejaculation (PE) is the most common self-reported sexual disorder among men, affecting up to 20% of the population. Recently, the injection of hyaluronic acid (HA) as a bulking agent into the glans of the penis was proposed as a promising modality for PE. It is believed to act as a barrier between the skin and nerve terminals, leading to decreased sensation of the glans penis, indirectly improving the outcome of PE. This scoping review aims to provide an overview of the techniques, efficacy, and safety of the injection of HA for PE derived from the existing scientific literature.Main bodyA literature search was conducted using PubMed, Scopus, and Web of Science databases and the keywords “hyaluronic acid” and “premature ejaculation.” Original articles were selected for further evaluation, while both case reports and case series were excluded. After the screening, ten relevant studies were included, with two main methods of injection, the Fanning technique and multiple puncture techniques, which were applied in the previous studies. All studies showed compelling improvements in both the intravaginal ejaculation latency time (IELT) and patients’ satisfaction. IELT increments may reach up to 8.54-fold even in the first month and sustain significantly up to 12 months. The complications reported, such as bleeding, pain, swelling, and discoloration, were mild and self-limited, which then resolved between 2 weeks and 1 month. No serious adverse events were reported.ConclusionsWith adequate surgical training and proper patient selection, penile augmentation using hyaluronic acid is a safe and effective method in the management of premature ejaculation.