Premature Ejaculation Diagnostic Tool Score Research Articles

Repeated sexual intercourse as a coping strategy for men with premature ejaculation.

Patients with premature ejaculation (PE) are often concerned and distressed about their sexual performance. Hence, they may be more willing to exploit their refractory period to employ sexual coping strategies in order to improve their unsatisfactory sexual intercourse compared with patients without PE. The study sought to verify the sexual coping strategies of patients with PE in the daily sexual activities. We included both patients with PE and individuals without PE and analyzed their sexual behaviors and attitudes by means of detailed interviews and questionnaires. The main outcomes were perceived intravaginal ejaculatory latency time recording, Premature Ejaculation Diagnostic Tool score, and sexual frequency, attitudes, and behavior log. A total of 182 young patients with PE (age 31.2 ± 6.2 years) and 92 individuals without PE (age 30.7 ± 5.1 years) were included in the study. A total of 53.3% of patients with PE vs 17.4% of individuals without PE reported engaging in multiple sexual intercourse sessions within a single day in the past 4 weeks. PE patients who engaged in multiple intercourse sessions displayed better performance during the second attempt but performed poorly compared with individuals without PE. Scores for the first attempt in PE vs second attempt in individuals with PE vs without PE were the following: intravaginal ejaculatory latency time, 2.4 ± 1.6 vs 4.8 ± 5.7 vs 9.9 ± 9.4 (P < .001); Premature Ejaculation Diagnostic Tool, 14.9 ± 3.1 vs 12.7 ± 4.8 vs 5.2 ± 2.5 (P < .001); satisfaction, 2.9 ± 1.0 vs 3.1 ± 0.8 vs 3.7 ± 1.4 (P < .001). A total of 57.1% of patients held a negative attitude toward precoital masturbation, for reasons such as a reduced sexual desire (21.2%), the belief that masturbation is harmful (17.6%), concerns about erectile function (15.7%), fatigue (9.8%), and other mixed reasons (35.3%). Engaging in multiple intercourse sessions within a day is more common among the young PE population, and using precoital masturbation as a coping strategy is not universally applicable among patients with PE. This is the first study to explore symptom-coping strategies in patients with PE compared with individuals without PE. However, the conclusions cannot be generalized to the entire male population. Patients with PE, compared with individuals without PE, are more inclined to engage in multiple sexual intercourse sessions within a single sexual session, likely in an attempt to compensate for their first unsatisfactory sexual encounter. Moreover, the majority of patients with PE here studied hold a negative attitude toward using precoital masturbation as a coping strategy for symptoms.

Psychological and sexological assessment of patients with chronic prostatitis

Purpose: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is characterized by a multiform clinical presentation requiring a differentiated treatment based on different phenotypes including the psychosocial and sexual domains. The aim of this study was assessing the complex correlations between somatic, psychological, and sexual symptoms of CP/CPPS patients. Materials and methods: We performed a cross-sectional study on patients attending a Prostatitis Clinic. Patients were administered the following questionnaires: National Institutes of Health- Chronic Prostatitis Symptom Index (NIH-CPSI), International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), Premature Ejaculation Diagnostic Tool (PEDT), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-item (GAD-7), Oxford Happiness Questionnaire (OHQ), and Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A). Results: Linear regression analyses show highly significant correlations between scores of the NIH-CPSI and the scores of the GAD-7, PHQ-9 and OHQ psychometric questionnaires. IPSS scores correlate significantly with the psychometric scores only when a non-parametric analysis is performed. IIEF and PEDT sexual function scores did not correlate with any of the psychometric tests. NIH-CPSI scores correlate positively with most of the TEMPS-A profiles but the hyperthymic profile correlated negatively with the total and QoL NIH-CPSI and with PEDT scores. Conclusions: Scores measuring anxiety, depression, and psychological well-being in patients with CP/CPPS are strictly correlated with prostatitis-like symptoms although they are poorly correlated with symptoms of prostatism, as measured by IPSS, and not correlated with scores of sexual dysfunctions, as measured by IIEF and PEDT. A hyperthymic temperament may increase resilience against the disease. 

Correlation between serum tryptophan metabolism and treatment efficacy of dapoxetine in patients with premature ejaculation: A pilot study.

Primary premature ejaculation (PPE) is a common male neurobiological disorder. Currently, there is consensus that the impairment in central serotonin (5-HT) neurotransmission constitutes a key pathogenic factor in PPE. Selective serotonin reuptake inhibitors (SSRIs) serve as the primary pharmacological intervention; however, a comprehensive elucidation of their mechanism of action remains incomplete. Owing to significant individual variability in efficacy, SSRIs exhibit a high discontinuation rate. Hence, there is an urgent need to address the selection of SSRIs for PPE treatment. This study aims to investigate the characteristics of tryptophan (TRP) metabolism in patients with PPE and to assess its influence on the efficacy of SSRIs. The exploratory study included a total of 16 patients with PPE and 16 control subjects who were healthy men without any sexual dysfunction. Upon enrollment in the study, all participants underwent a thorough medical history review and physical examination. Subsequently, their serum levels of TRP, its metabolites, large neutral amino acids (LNAAs), and metabolite ratios were assessed using a liquid chromatography-mass spectrometry (LC-MS) assay. After a period of 4weeks of dapoxetine treatment, all patients with PPE underwent reassessment using the Premature Ejaculation Diagnostic Tool (PEDT) score and intravaginal ejaculatory latency time (IELT) test. The ratio of serum TRP to other LNAAs (TRP/LNAAs) in patients with PPE was found to be significantly lower compared to the control group (P<0.05). Conversely, the ratio of kynurenine to TRP (KYN/TRP) was observed to be significantly higher in the PPE patients compared to the control group (P<0.05). Including the serum TRP/LNAAs ratio and KYN/TRP ratio in the prediction model yielded the highest prediction efficiency for PPE. There was a significant negative correlation between the ratio of TRP/LNAAs before the treatment and the IELT after 4weeks of the treatment. Additionally, there was a significant positive correlation observed between the ratio of TRP/LNAAs before the treatment and the PEDT score after 4weeks of the treatment. This study demonstrates that the reduction in the TRP/LNAAs ratio and the elevation of the KYN/TRP ratio are significant characteristics associated with PPE. These findings suggest that diminished tryptophan availability in the brain and the activation of the kynurenine (KYN) pathway may play a role in the pathogenesis of PPE. The TRP/LNAAs ratio has potential as a reliable indicator of central serotonin (5-HT) levels. Considering the TRP/LNAAs ratio when selecting SSRIs for the treatment of PPE may enhance the response rate of this medication.

Analysis of orthostatic intolerance symptoms in patients with premature ejaculation.

The autonomic nervous system (ANS) plays an important role in maintaining physiological regulation. It regulates the body's response to many variable situations. Orthostatic intolerance (OI) is one of the most important signs of autonomic dysfunction. Autonomic dysfunction is known to cause premature ejaculation (PE) by disturbing the balance in erection and ejaculation cycles. Considering that OI may develop due to autonomic dysfunction in patients with PE, we hypothesized that OI symptoms would increase in these patients. The aim of our study was to investigate the relationship between orthostatic intolerance and PE. This case-control study included a total of 39 patients with PE and 47 volunteers without PE. All subjects were assessed using the self-reported Orthostatic Grading Scale (OGS). In addition, the validated five-item Turkish version of the Premature Ejaculation Diagnostic Tool (PEDT) was used to evaluate PE. The PE group included patients with a PEDT score ≥ 11. The mean ages of the PE and control groups were 38.2 ± 7.8 and 40.5 ± 9.1 years, respectively (p = 0.137). The mean PEDT scores of the PE and control groups were 13.9 ± 3.6 and 6.6 ± 2.9, respectively (p < 0.0001), and their mean OGS scores were 5.6 ± 2.4 and 1.6 ± 1.3, respectively (p < 0.0001). A statistically significant correlation was found between the PEDT and OGS scores (r: 0.686, p < 0.0001). The orthostatic intolerance symptoms of patients with PE were higher than those of the control group. There was a correlation between the severity of PE and the severity of orthostatic intolerance. This is the first study in the literature to reveal a relationship between orthostatic intolerance and PE.

Impact of sexual function domains on sexual satisfaction and quality of life: Importance across the age spectrum.

Sexual satisfaction is an important component of global quality life for many adult men. Substantial gaps exist in our appreciation of how age mediates sexual satisfaction in the context of functional sexual measures. We sought to evaluate modifiable factors associated with overall sexual satisfaction and health-related quality of life (HRQoL) in a large, age-stratified community-based sample of adult men. A sample of adult males registered with the online research service ResearchMatch completed a 75-item online questionnaire in this cross-sectional study. Queries included demographics, general health data, and validated sexual health measures including International Index of Erectile Function-5 (IIEF-5) and Premature Ejaculation Diagnostic Tool (PEDT). Multivariable regression was performed to assess associations with self-reported sexual satisfaction (defined by "moderately satisfied" or "very satisfied" on the 5-level Likert scale) and overall HRQoL (as measured by the EQ-5D-visual analog scale (VAS) stratified by age. One thousand thirty-three men completed the survey and were stratified by age cohorts. IIEF-5 and PEDT scores were higher in younger cohorts. On multivariable regression analysis, higher IIEF-5, lower PEDT, better overall health-related quality of life, and the presence of a sexual partner within the last month were associated with an increased likelihood of overall sexual satisfaction. When stratified by age cohort, higher IIEF-5 scores were consistently positively associated with sexual satisfaction (Odds Ratio (OR) 1.18, 95% CI 1.15-1.22, P < 0.001), as well as independently associated with improved overall HRQoL by EQ-5D-VAS (β = 0.71, Standard Error (SE) = 0.08, P < 0.001). The erectile function was independently associated with sexual satisfaction and quality of life across all age strata and predictive of both sexual satisfaction and global HRQoL. Low overall rates of sexual satisfaction across cohorts highlight the critical importance of evaluation and treatment of sexual health, regardless of age.

Regular penis-root masturbation: A promising behavioral treatment method for lifelong premature ejaculation.

We aimed to determine the effectiveness of penis-root masturbation (PRM), a newly defined behavioral therapy (BT) technique, in patients with unsuccessful medical treatment due to premature ejaculation (PE). The study included 35 patients aged 25-43 years, who were diagnosed with lifelong PE. Patients and their partners were informed about the PRM technique and asked to practice PRM three times a week for three months, with or without sexual intercourse. The patients' Premature Ejaculation Diagnostic Tool (PEDT) scores and intravaginal ejaculatory latency time (IELT) were recorded and compared before PRM training (T0) and at the third (T3) month after the start of PRM training. The mean±SD PEDT scores were 16.26±1.94 at T0, 10.63±1.14 at T3. When compared to T0, the PEDT values at T3 were significantly lower (P=0.021). In terms of IELT, the mean T3 values (192.43±56.71) were significantly longer (P=0.035) than at T0 (50.43±13.84seconds). PRM BT shows promise for lifelong PE patients who do not benefit from or discontinue to pharmacotherapy. Larger prospective trials are required to confirm these findings.

Efficacy Analysis of Physical Therapy in Treating Chronic Prostatitis: Unblocking Obstructed Glandular Ducts Could Be a Novel Treatment Strategy.

This study investigates the efficacy of physical therapy in treating chronic prostatitis grounded on the glandular duct blockage theory. The study includes patients who were diagnosed and treated for chronic prostatitis between November 2022 and July 2023 at Renhui clinic in Jiangmen, Guangdong and Renhui frontline clinic in Shenzhen Guangdong. The recorded data includes the frequency of physical therapies including prostate massages, rectal probe high-frequency vibration treatment, and low-intensity extracorporeal shockwave therapy (Li-ESWT). Post-treatment urine sediment was collected for microscopic examination, and the scores of each patient on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the Premature Ejaculation Diagnostic Tool (PEDT) were recorded pre- and post-treatment in order to calculate the effectiveness rate. The study involved a total of 48 patients, of which 26 were diagnosed with premature ejaculation. On average, each patient received 2.1 prostate massages, underwent 4.1 rectal probe high-frequency vibration treatments, and 8.3 Li-ESWT sessions. Following treatment, the initial microscopic examination of the urine sediment revealed aged white blood cell clusters, prostate calculi clusters, and inactive sperm clusters, all appearing in the shape of glandular tubes. The mean NIH-CPSI scores pre- and post-treatment were 27.2±6.9 and 18.0±6.6, respectively, indicating an effectiveness rate of 81.3%. The average PEDT scores pre- and post-treatment were 14.5±3.5 and 10.5±4.2, respectively, with an effectiveness rate of 53.8%. Unblocking obstructed glandular ducts might provide a novel therapeutic strategy for treating chronic prostatitis.

Decreased grey matter volume in dorsolateral prefrontal cortex and thalamus accompanied by compensatory increases in middle cingulate gyrus of premature ejaculation patients.

The prefrontal-cingulate-thalamic areas are associated with ejaculation control. Functionalabnormalities of these areas and decreased grey matter volume (GMV) in the subcortical areas have been confirmed in premature ejaculation (PE) patients. However, no study has explored the corresponding GMVchanges in the prefrontal-cingulate-thalamic areas, which are considered as the important basis for functionalabnormalities. This study aimed to investigated whether PE patients exhibited impaired GMV in the brain, especially the prefrontal-cingulate-thalamic areas, and whether these structural deficits were associated with declined ejaculatory control. T1-weighted structural magnetic resonance imaging (MRI) data were acquired from 50 lifelong PE patients and 50 age-, and education-matched healthy controls (HCs). The PE diagnostic tool (PEDT) was applied to assess the subjective symptoms of PE. Based on the method of voxel-based morphometry (VBM), GMV were measured and compared between groups. In addition, the correlations between GMV of brain regions showed differences between groups and PEDT scores were evaluated in the patient group. PE patients showed decreased GMV in the right dorsolateral superior frontal gyrus (clusters=13, peak T-values=-4.30) and left thalamus (clusters=47, T=-4.33), and increased GMV in the left middle cingulate gyrus (clusters=12, T=4.02) when compared with HCs. In the patient group, GMV of the left thalamus were negatively associated with PEDT scores (r=-0.35; P=0.01). Receiver operating characteristic (ROC) analysis showed that GMV of the right dorsolateral superior frontal gyrus (AUC=0.71, P<0.01, sensitivity=60%, specificity=78%), left thalamus (AUC=0.72, P<0.01, sensitivity=92%, specificity=46%) and middle cingulate gyrus (AUC=0.69, P<0.01, sensitivity=50%, specificity=90%), and the combined model (AUC=0.84, P<0.01, sensitivity=78%, specificity=80%) all had theability to distinguish PE patients from HCs. Disturbances in GMV were revealed in the prefrontal-cingulate-thalamic areas of PE patients. The findings implied that decreased GMV in the dorsolateral prefrontal cortex and thalamus might be associated with the central pathological neural mechanism underlying the declined ejaculatory control while increased GMV in the middle cingulate gyrus might be the compensatory mechanism underlying PE.

Impact of type D personality and depressive symptoms on premature ejaculation in young adult males.

Premature ejaculation (PE) is one of the most common male sexual dysfunctions with prominent psychological consequences. Type D personality (TDP) is also associated with multiple psychological disorders, such as depression and anxiety. However, the correlation between PE and TDP remains unknown. The study sought to investigate the relationships between depressive symptoms, TDP, and PE. Adult males in Taiwan who were 20 to 40years of age and who had sexual intercourse in the past 6 months were recruited to complete online questionnaires composed of general demographics, the Premature Ejaculation Diagnostic Tool (PEDT), 5-item International Index of Erectile Function (IIEF-5), Type D Scale-14, and Depression and Somatic Symptom Scale (DSSS). Chi-square test and independent Student's t test were used to compare the parameters between the TDP and non-TDP groups. Univariate and multivariate logistic regression analyses were conducted to evaluate factors related to PE. Outcomes were the prevalence of PE and TDP in young Taiwanese men, the associations between depressive symptoms and PE and TDP, and the predictive factors of PE. In total, 2558 men with a mean age of 31.3 ± 5.3years were included in the present study. Among them, 315 (12.3%) and 767 (30.1%) participants were classified as having PE and moderate-to-severe erectile dysfunction (ED), respectively. In total, 1249 (48.8%) participants met the criteria for TDP. The PEDT, IIEF-5, and DSSS, including the total scores and depression and somatic subscales, were significantly higher in men with TDP (all P < .001). PE prevalence was significantly greater in men with TDP than in those without TDP (16.2% vs 8.6%; P < .001). Most parameters, including age, moderate-to-severe ED, the Type D Scale-14 subscales, and the DSSS somatic and depressive subscales, were significantly associated with PE in the univariate analysis. Only the depressive subscale of the DSSS and moderate-to-severe ED (IIEF-5 ≤16) were the independent predictors of PE in the multivariate analysis. The results suggest that it is important to consider the psychological effects of PE in young men, and the study has provided a biopsychosocial aspect to manage patients with PE. This is the first study to evaluate the association between PE, TDP, and depression in a large population of young adult males. However, the cross-sectional design may have limited the investigation of causality, and selection bias may be present. Men with TDP tended to have higher PEDT scores and a prevalence of PE and ED. Moderate-to-severe ED and depressive symptoms are the independent predictive factors of PE.

Perceived intravaginal ejaculation latency time: The diagnosis of premature ejaculation among Vietnamese men.

Premature ejaculation (PE) is a prevalent sexual dysfunction in men that greatly affects their quality of life. In PE, the duration of sexual performance is considered an important aspect. However, a self-estimated value of intravaginal ejaculation latency time (perceived IELT, PIELT) as a criterion for diagnosis has not been specified. This study aimed to determine the validity and a threshold value for PIELT in PE diagnosis. In our cross-sectional study, we recruited 550 men from March 2019 to January 2020 and interviewed them regarding their general demographic characteristics, sexual habits, PIELT and completed a premature ejaculation diagnostic tool (PEDT) questionnaire. Eventually, a combination of a clinical diagnosis and PEDT score was used, in which those with PEDT ≥ 11 and diagnosed with possible PE were assigned to the final PE(+) group; those with PEDT score ≤ 8 and diagnosed with no PE were included in the final PE(-) group. Men PE(-) had more frequent sexual intercourse (9.74±5.38vs. 6.69±5.38 episodes per month, p<0.001) and had higher marriage rate (72.7%vs. 60.4%, p=0.002) than PE(+) patients. No significant difference was noted regarding age, smoking habit, age of first sexual experience, and number of sexual partners between the two groups. The mean PIELT of control subjects and PE(+) patients were 11.69±6.83 min and 2.01±1.21 min, respectively. On receiver operating characteristic curve analysis, the cut-off value of PIELT of 3.75 min can be used to distinguish PE men (area under the curve=0.982, sensitivity/specificity=0.961/0.909), which means that men with a PIELT ≤ 3.5 min is suggestive of PE. The impact of PE is dramatic both from a social and a personal perspective. PE(+) patients married significantly less and have significantly lower sexual activity compared to a PE(-) population. Furthermore, a PIELT of ≤ 3.5 min predicts PE demonstrating the need to revise its taxonomy and definition.

Acupuncture for premature ejaculation: a systematic review and meta-analysis.

Although acupuncture is widely used to treat premature ejaculation (PE), its effectiveness remains highly controversial. To evaluate the efficacy and safety of acupuncture on PE. According to the relevant keywords, 11 major English and Chinese databases were searched for randomized controlled trials (RCTs) of acupuncture alone or in combination with other treatments for PE. The quality of evidence across studies was assessed by the GRADEpro tool. Study outcome measures included the intravaginal ejaculation latency time (IELT), the Premature Ejaculation Diagnostic Tool (PEDT), the Chinese Index of Premature Ejaculation-5 (CIPE-5), treatment success rate, and adverse events. Seven trials were included in this review for a total of 603 participants. A low quality of evidence suggests that it is not possible to determine whether acupuncture, as compared with a selective serotonin reuptake inhibitor, has an advantage in improving the IELT (standardized mean difference [SMD], -1.75; 95% CI, -6.12 to 2.63; P = .43, I2 = 98%), PEDT scores (SMD, 0.32; 95% CI, -0.68 to 1.32; P = .53, I2 = 85%), and treatment success rate (risk ratio, 0.69; 95% CI, 0.41-1.14; P = .15). However, participants receiving acupuncture had a lower CIPE-5 (SMD, -1.06; 95% CI, -1.68 to -0.44; P < .01). As compared with sham acupuncture, acupuncture significantly improved the IELT (SMD, 1.47; 95% CI, 1.01-1.92; P < .01, I2 = 0%) and PEDT scores (SMD, -1.23; 95% CI, -1.78 to -0.67; P < .01, I2 = 37%). When compared with other treatments alone, a combined treatment with acupuncture can significantly improve the IELT (SMD, 7.06; 95% CI, 2.53-11.59; P < .01, I2 = 97%), CIPE-5 (SMD, 0.84; 95% CI, 0.45-1.22; P < .01, I2 = 0%), and treatment success rate (SMD, 1.60; 95% CI, 1.18-2.16; P < .01, I2 = 53). The results suggest a significant effect of acupuncture in the treatment of certain important indicators of PE; however, this finding needs to be treated with caution because of the quality of the RCTs included. Comprehensive inclusion of available RCTs has been performed. However, limitations include a low number of studies and a lack of detailed information to allow subgroup analysis. The present systematic review and meta-analysis show that acupuncture has a significant effect on several subjective PE parameters, such as improving the feeling of control over ejaculation and distress, particularly when used in an integrated way. However, due to the low quality of evidence, acupuncture still needs larger well-designed RCTs to be confirmed.

Short‐term effect of the prone masturbation training on premature ejaculation

AbstractBackgroundWhether conventional behavioral therapies for premature ejaculation can significantly improve the intravaginal ejaculatory latency time is still controversial. Prone masturbation is rare and observed in some patients with delayed ejaculation. Therefore, we tried to verify whether the regular prone masturbation training method had a therapeutic effect on premature ejaculation.MethodsFrom July to December 2018, a total of 21 patients met the enrollment criteria and volunteered to participate. Participants were diagnosed with premature ejaculation with an intravaginal ejaculatory latency time of less than 3 min and a Premature Ejaculation Diagnostic Tool score greater than 9. Participants performed 12‐week prone masturbation training.ResultsTen patients completed the entire treatment regimen. The mean age of the 10 participants was 30.4 ± 6.1 years, the mean frequency of sexual intercourse was 1.9 ± 0.83 times a week, and the median duration of premature ejaculation was 1.5 years. After 3 months of prone masturbation training, the median self‐reported intravaginal ejaculatory latency time significantly increased from 60 to 105 s (p = 0.011), and the mean Premature Ejaculation Diagnostic Tool scores decreased from 15.0 ± 3.7 to 12.7 ± 3.7 points (p = 0.119).ConclusionsThe regular prone masturbation training method, as a novel behavioral therapy, probably has a therapeutic effect on premature ejaculation.

The relationship between four types of premature ejaculation patients and the quality of residential environment

BackgroundWe investigated the association between premature ejaculation (PE) and the quality of residential environment from a new perspective to explore the influencing factors of PE, especially in four PE subtypes. We selected 499 adult males to participate in this study from September 2021 to September 2022. The satisfaction of residential environment was assessed by the Perceived Residential Environment Quality Indicators (PREQIs) scale, the control ability over ejaculation was assessed using the premature ejaculation diagnostic tool (PEDT), and their depression was assessed using the self-rating depression scale (SDS).ResultsThe Architectural and Town-planning Spaces (ATS), Green Spaces (GS), and Commercial Services (CS) of PE patients (N = 346) were compared with those of control group (N = 153), showed a significant difference (p < .05), for PE patients, the score of ATS was 44.30 ± 12.38, the score of GS was 18.60 ± 6.24, and the score of CS was 20.82 ± 8.20; for control group, which were 40.46 ± 16.21, 20.69 ± 5.71 and 22.90 ± 7.03 respectively. After age was taken into account, ATS had a positive correlation with PEDT score (r = 0.76), whereas GS and CS had a negative correlation (r = -0.87, -0.90); ATS had a positive correlation with SDS (r = 0.96), whereas GS and CS had a negative correlation (r = -0.74, -0.81).ConclusionsWe discovered that PE patients more likely resided in high-density areas with little green space and subpar commercial services, which might have an adverse effect on their mental health. This study offered a new viewpoint about the influence of residential environment on PE.

PD11-06 LONG TERM FOLLOW-UP OUTCOMES OF PELVIC FLOOR REHABILITATION IN SUBJECTS SUFFERING FROM LIFELONG PREMATURE EJACULATION: RETROSPECTIVE MULTICENTRE STUDY

You have accessJournal of UrologyCME1 Apr 2023PD11-06 LONG TERM FOLLOW-UP OUTCOMES OF PELVIC FLOOR REHABILITATION IN SUBJECTS SUFFERING FROM LIFELONG PREMATURE EJACULATION: RETROSPECTIVE MULTICENTRE STUDY Antonio Luigi Pastore, Yazan Al Salhi, Andrea Fuschi, Alessia Martoccia, Fabio Maria Valenzi, Alessandro Sciarra, Stefano Salciccia, de Nunzio Cosimo, Andrea Tubaro, Costantino Leonardo, Giorgio Franco, and Antonio Carbone Antonio Luigi PastoreAntonio Luigi Pastore More articles by this author , Yazan Al SalhiYazan Al Salhi More articles by this author , Andrea FuschiAndrea Fuschi More articles by this author , Alessia MartocciaAlessia Martoccia More articles by this author , Fabio Maria ValenziFabio Maria Valenzi More articles by this author , Alessandro SciarraAlessandro Sciarra More articles by this author , Stefano SalcicciaStefano Salciccia More articles by this author , de Nunzio Cosimode Nunzio Cosimo More articles by this author , Andrea TubaroAndrea Tubaro More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , Giorgio FrancoGiorgio Franco More articles by this author , and Antonio CarboneAntonio Carbone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003251.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of the study is to investigate the long-term follow-up outcomes of pelvic floor muscle (PFM) rehabilitation in males suffering from lifelong premature ejaculation (LPE). To evaluate LPE, patients were investigated with intravaginal ejaculatory latency time (IELT) and the self-report Premature Ejaculation Diagnostic Tool (PEDT). These two collected data represented the primary outcome endpoints. METHODS: This retrospective study evaluated 227 subjects with LPE diagnosis, and a total of 171 pts out of 227 (75%) completed the training protocol and at least the follow-up of 72 months. At baseline, all participants reported an IELT ≤60 s and PEDT score >11. Participants completed a 12-week program of PFM rehabilitation, including physio-kinesiotherapy treatment, electrostimulation, and biofeedback, with three sessions per week, with 20 min for each component completed at each session. The effectiveness of intervention was evaluated by comparing the geometric means of IELT times and PEDT scores observed from baseline, to 6, and 12 months during the intervention, and at 24, 36, 48, 60 and 72 months postintervention, using a paired sample 2-tailed t-test, including the associated 95% confidence intervals. RESULTS: One hundred seventy-one participants completed the PFM rehabilitation protocol with 36 sessions of PFM. All subjects achieved the control of ejaculation reflex, reporting a mean IELT of 181.4 s and PEDT score of 2.5 at the 12-week endpoint of the intervention, representing an increase from baseline of 54.9 s and 16.6 scores, respectively, for IELT and PEDT (p < 0.0001). Of the 171 participants who completed the 60-month follow-up, 80%, 78%, 74%, 69 and 67% reported a satisfactory ejaculation control maintenance through the follow-up evaluations at 24, 36, 48, 60 and 72 months after completing PFM rehabilitation, respectively. CONCLUSIONS: Our study is the first on LPE treatment with such long-term follow-up (6 years). The results observed are statistically significant and support a role of PFM as an effective and safe therapy in LPE subjects. A prospective randomized study is requested to assess the role of PFM in PE. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e334 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antonio Luigi Pastore More articles by this author Yazan Al Salhi More articles by this author Andrea Fuschi More articles by this author Alessia Martoccia More articles by this author Fabio Maria Valenzi More articles by this author Alessandro Sciarra More articles by this author Stefano Salciccia More articles by this author de Nunzio Cosimo More articles by this author Andrea Tubaro More articles by this author Costantino Leonardo More articles by this author Giorgio Franco More articles by this author Antonio Carbone More articles by this author Expand All Advertisement PDF downloadLoading ...

MP45-06 THE CLINICAL PROFILE OF MEN WITH PREMATURE EJACULATION AT PRESENTATION HAS CHANGED OVER THE LAST FIFTEEN YEARS: ANALYSIS FROM A LONGITUDINAL STUDY

You have accessJournal of UrologyCME1 Apr 2023MP45-06 THE CLINICAL PROFILE OF MEN WITH PREMATURE EJACULATION AT PRESENTATION HAS CHANGED OVER THE LAST FIFTEEN YEARS: ANALYSIS FROM A LONGITUDINAL STUDY Luca Boeri, Edoardo Pozzi, Federico Belladelli, Giuseppe Fallara, Simone Cilio, Alessandro Bertini, Francesco Lanzaro, Luigi Candela, Christian Corsini, Massimiliano Raffo, Fausto Negri, Ludovica Cella, Margherita Fantin, Paolo Capogrosso, Francesco Montorsi, and Andrea Salonia Luca BoeriLuca Boeri More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Simone CilioSimone Cilio More articles by this author , Alessandro BertiniAlessandro Bertini More articles by this author , Francesco LanzaroFrancesco Lanzaro More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Christian CorsiniChristian Corsini More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Fausto NegriFausto Negri More articles by this author , Ludovica CellaLudovica Cella More articles by this author , Margherita FantinMargherita Fantin More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003291.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patient’s characteristics at first medical evaluation for a specific sexual dysfunction (SD) are correlated to the public awareness towards the specific disease and the availability of novel treatments. We aimed to assess the clinical characteristics of patients presenting for premature ejaculation (PE) as their primary medical complaint over a 15-year time frame. METHODS: Data from 257 sexually active, heterosexual men seeking first medical help for primary PE at a single sexual medicine academic clinic between 2008 and 2022 were analysed. Clinical data and serum hormones were collected. At baseline all patients completed the International Index of Erectile Function (IIEF), the Beck Inventory for Depression (BDI), and the Premature Ejaculation Diagnostic Tool (PEDT). Relationship status was categorized as: single vs. stable sexual relationship. Descriptive statistics and linear regression analyses were used to describe the whole cohort. RESULTS: Median (IQR) age at presentation was 32 years. Of all, 182 patients reported some degree of erectile dysfunction (ED) according to IIEF-EF scores. Median baseline PEDT and BDI score were 14 and 7, respectively. Median total testosterone and TSH values were 5.2 ng/ml and 1.6 mUI/L, respectively. Across the 15-year time frame, patient’s age at presentation significantly decreased over time (p<0.001). Furthermore, depressive symptoms at BDI (p<0.001) and PE severity as scored with the PEDT (p<0.001) linearly decreased overtime. When segregating the whole cohort into 5-year groups, age at presentation decreased from 2008-2012 to 2013-2017 (p=0.04) and further decreased between 2018-2022 (p=0.01). Similarly, baseline BDI scores decreased from 2008-2012 to 2018-2022 (all p<0.001). PE severity at first assessment was stable between 2008-2012 to 2013-2017 but decreased thereafter. Patients in a stable couple relationship more frequently asked for medical attention for PE between 2018-2022 compared to 2013-2017 and 2008-2012. CONCLUSIONS: Findings from this study showed that PE patients characteristic at first presentation has changed throughout the last 15 years. Of note, age, PE severity and depressive symptoms showed a significant decline overtime. Men in a stable sexual relationship were more likely to seek medical attention for PE in recent years. These results probably reflect the increased public awareness of PE; therefore, patients request PE consultation at younger age, with initial symptoms and with fewer psychological bother related to this condition. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e623 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luca Boeri More articles by this author Edoardo Pozzi More articles by this author Federico Belladelli More articles by this author Giuseppe Fallara More articles by this author Simone Cilio More articles by this author Alessandro Bertini More articles by this author Francesco Lanzaro More articles by this author Luigi Candela More articles by this author Christian Corsini More articles by this author Massimiliano Raffo More articles by this author Fausto Negri More articles by this author Ludovica Cella More articles by this author Margherita Fantin More articles by this author Paolo Capogrosso More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF downloadLoading ...

MP79-14 COMPLIANCE TO ORAL TREATMENT FOR PREMATURE EJACULATION – DATA FROM A SINGLE ACADEMIC CENTER

You have accessJournal of UrologyCME1 Apr 2023MP79-14 COMPLIANCE TO ORAL TREATMENT FOR PREMATURE EJACULATION – DATA FROM A SINGLE ACADEMIC CENTER Paolo Capogrosso, Edoardo Pozzi, Federico Belladelli, Giuseppe Fallara, Simone Cilio, Massimiliano Raffo, Fausto Negri, Ludovica Cella, Margherita Fantin, Alessandro Bertini, Luca Boeri, Christian Corsini, Francesco Lanzaro, Luigi Candela, Alessia D'Arma, Federico Dehò, Francesco Montorsi, and Andrea Salonia Paolo CapogrossoPaolo Capogrosso More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Simone CilioSimone Cilio More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Fausto NegriFausto Negri More articles by this author , Ludovica CellaLudovica Cella More articles by this author , Margherita FantinMargherita Fantin More articles by this author , Alessandro BertiniAlessandro Bertini More articles by this author , Luca BoeriLuca Boeri More articles by this author , Christian CorsiniChristian Corsini More articles by this author , Francesco LanzaroFrancesco Lanzaro More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Alessia D'ArmaAlessia D'Arma More articles by this author , Federico DehòFederico Dehò More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003356.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Oral therapy for premature ejaculation (PE) has been associated with high drop-out rates due to side effects and poor results. We compared patients compliance to dapoxetine prn vs. paroxetine OaD in men with PE in a real-life setting. METHODS: Data from 4105 patients with sexual dysfunctions prospectively collected at a single Sexual Medicine clinic in 2005-2022 were analysed. Overall, 342(8.3%) patients complained of PE and were treated either with dapoxetine 30-60mg prn or paroxetine 20mg OaD according to patients’ profile and preference. All completed the Premature Ejaculation Diagnostic Tool (PEDT) and the IIEF before and over the treatment course. Patients were re-assessed at 3 months from treatment start and thereafter every 6 months or as needed. Kaplan-Meier estimated treatment drop-out rates over time. Cox regression analysis assessed predictors of treatment discontinuation. RESULTS: Median (IQR) age was 47(36, 61) years. Median baseline PEDT score was 15 (10,17.5). Of all, 151(44%) and 191(56%) patients were treated with dapoxetine and paroxetine respectively. Patients receiving dapoxetine were younger (40(30,48) vs. 56(41,67); p<0.0001) and depicted worse baseline PEDT (16(14,18) vs. 8(3,14); p<0.0001) as compared with those receiving paroxetine. Overall, 329(96%) discontinued the drugs at some point throughout the treatment course, showing only a slight mean improvement of PEDT from baseline of -0.4(95%CI:-0.8,1.7) and -0.8(95%CI:-0.7,1.3) with dapoxetine and paroxetine, respectively. At Kaplan-Meier (Figure 1) the two groups did not differ in terms of treatment dropout over time (p=0.3), with estimated discontinuation rates of 27%(15,45) and 55%(37,75) at 12 and 24 months for dapoxetine and 13%(7,24) and 47%(32,65) for paroxetine. Younger patients were at higher risk of treatment drop-out (HR:0.95, 95%CI:0.91,0.99; p=0.03) after accounting for PEDT, IIEF-EF and type of treatment. CONCLUSIONS: PE still represents a therapeutic challenge with high treatment drop-out rates and only minor improvements. Younger patients appear at higher risk of oral therapies discontinuation and maybe better candidates for a multimodal treatment. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1146 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paolo Capogrosso More articles by this author Edoardo Pozzi More articles by this author Federico Belladelli More articles by this author Giuseppe Fallara More articles by this author Simone Cilio More articles by this author Massimiliano Raffo More articles by this author Fausto Negri More articles by this author Ludovica Cella More articles by this author Margherita Fantin More articles by this author Alessandro Bertini More articles by this author Luca Boeri More articles by this author Christian Corsini More articles by this author Francesco Lanzaro More articles by this author Luigi Candela More articles by this author Alessia D'Arma More articles by this author Federico Dehò More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF downloadLoading ...

Clinical value of penile sympathetic skin response to assess the efficacy of sertraline in the treatment of patients with sympathetic hyperexcitability in primary premature ejaculation.

The pathogenesis of primary premature ejaculation (PPE) is complex, and the pathologic basis may be an overactive sympathetic nervous system. To investigate sertraline efficacy in patients with sympathetic hyperexcitability in PPE and clarify the value of penile sympathetic skin response (PSSR) in assessing the efficacy of sertraline for PPE treatment. Sixty-three patients with PPE were recruited in the outpatient clinic and asked to take 50mg of oral sertraline daily for a 4-week treatment period. Changes in intravaginal ejaculation latency time (IELT), Premature Ejaculation Diagnostic Tool, International Index of Erectile Function (IIEF-5), and PSSR latency and wave amplitude were compared before and after treatment. The principal aim was to determine the relationships among sertraline efficacy, IELT, and PSSR latency and amplitude. After sertraline treatment, patients with PPE demonstrated a significant decrease in Premature Ejaculation Diagnostic Tool scores (P < .001); a significant increase in IELT, PSSR latency, and wave amplitude (P < .001); and no significant change in International Index of Erectile Function scores (P > .05). Moreover, the latency changes of PSSR were positively correlated with the increment of IELT (r = 0.550, P < .001). In addition, there was some degree of improvement vs pretreatment, although IELT and PSSR latencies were significantly shorter after drug discontinuation when compared with posttreatment (both P < .001). We aimed to find an objective test that accurately reflects the efficacy of treatment for sympathetic hyperexcitability in PPE. The strengths include a well-powered study, use of validated instruments, and self-assessment of treatment benefit. The limitations include the single-center design, relatively short-term follow-up, and lack of more comprehensive monitoring between treatment and drug discontinuation. These findings suggest that sertraline is effective for PPE treatment, that its efficacy can be partially maintained even after drug discontinuation, and that PSSR may be reliable for evaluating treatment success in patients with PPE.

Abnormal cortical surface-based spontaneous and functional connectivity in the whole brain in lifelong premature ejaculation patients.

Recent research has highlighted structural and functional abnormalities in the cerebral cortex of patients with premature ejaculation (PE). These anomalies could play a pivotal role in the physiological mechanisms underlying PE. This study leveraged functional magnetic resonance imaging (fMRI), a noninvasive technique, to explore these neural mechanisms. We conducted resting-state fMRI scans on 36 PE patients and 22 healthy controls (HC), and collected data on Premature Ejaculation Diagnostic Tool (PEDT) scores and intravaginal ejaculation latency time (IELT). Employing a surface-based regional homogeneity (ReHo) approach, we analyzed local neural synchronous spontaneous activity, diverging from previous studies that utilized a volume-based ReHo method. Areas with significant ReHo differences between PE and HC groups underwent surface-based functional connectivity (FC) analysis. Significant discrepancies in ReHo and FC across the cortical surface were observed in the PE cohort. Notably, PE patients exhibited decreased ReHo in the left triangular inferior frontal gyrus and enhanced ReHo in the right middle frontal gyrus. The latter showed heightened connectivity with the left lingual gyrus and the right orbital superior frontal gyrus. Furthermore, a correlation between ReHo and FC values with PEDT scores and IELT was found in the PE group. Our findings, derived from surface-based fMRI data, underscore specific brain regions linked to the neurobiological underpinnings of PE.

Erectile dysfunction, anxiety, perceived stress, and insomnia are more common among acquired premature ejaculation patients compared to other premature ejaculation syndromes.

Premature ejaculation (PE) is the most common ejaculatory function disorder. To date, four types of PE have been identified depending on the severity, onset, and course of the problem. The aim of this study was to investigate whether or not there is a difference between these types in respect of anxiety, perceived stress, insomnia severity, and sleep chronotype. The study included 112 patients diagnosed with PE in our clinic between October 2021 and May 2022. The patients were separated into groups according to PE types of lifelong (LPE, n = 39), acquired (APE, n = 45), variable (VPE, n = 10), and subjective (SPE, n = 18). In addition to the demographic and clinical data, the scores were recorded of all participants in the International Index of Erectile Function-5, Hospital Anxiety and Depression Scale, Premature Ejaculation Diagnostic Tool (PEDT), Insomnia Severity Index (ISI), Perceived Stress Scale (PSS), and Morningness Eveningness Questionnaire (MEQ). SPE was determined more in university graduate patients (42.1% vs. LPE, 21.1%; APE, 36.8%; VPE, 0%; p = 0.01). In patients with APE, erectile dysfunction was more severe (80.0% vs. LPE, 8.0%; SPE, 12.0%; VPE, 0%; p < 0.001). The median (IQR) PEDT score was determined to be higher in APE than in LPE and SPE (16(5), 13(7), 11(5), p = 0.001, respectively). Patients with APE were determined to have higher median (IQR) ISI (21(9) vs. LPE, 8(7); SPE, 5(8); VPE 8(4), p < 0.001) and PSS scores (35(12) vs. LPE, 22 (7); SPE,22(5); VPE 21(6), p < 0.001), the sleep chronotype was more eveningness according to the MEQ (80.8% vs. LPE, 19.2%; VPE, 0%; SPE, 0%; p < 0.001), and there were seen be more anxiety symptoms (75.5% vs. LPE,12.2%; VPE, 0%; SPE, 12.2%; p < 0.001). Psychological status and sleep health were concluded to be important factors for PE patients, and the patients with acquired PE were the group most affected by these factors.

The impact of the coronavirus disease 2019 (covid-19) on male sexual health

<h3>Objectives</h3> During the Coronavirus Disease 2019 (COVID-19) pandemic, there was an increase in the amount of men seeking treatment at urology outpatient clinics for sexual complaints. However, it is unknown whether this condition is directly related to COVID-19. The impact of COVID-19 on male sexual health was explored in the present study. <h3>Methods</h3> Individuals in the male sexual health cohort of our clinic were retrospectively examined. Men who applied to our clinic in the last 6 months and had a history of COVID-19 afterward were invited for an assesment at the 3rd month post COVID-19. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), and prolactin (PRL) levels were all measured. Furthermore, the Premature ejaculation diagnostic tool (PEDT), the Chronic prostatitis symptom index (NIH-CPSI), the International Index of erectile function-5 (IIEF-5), the Beck depression inventory (BDI), and the Beck anxiety inventory (BAI) scores were recorded. The pre-covid and post-covid data of the subjects were compared. <h3>Results</h3> The mean age of the participants was 34.8±7.7, the mean body mass index was 26.82±5.3, and the mean modified Charlson comorbidity index was 0.2±0.41. COVID-19 severity was mild in 19/25 (76%) and moderate in 6/25 (24%) of the subjects. LH, FSH, TT, and PRL levels did not differ between precovid and postcovid periods (p>0.05). There was no significant change in PEDT, NIH-CPSI, IIEF-5, or BAI scale scores in the postcovid period (p>0.05), although there was an remarkable decrease in BDI scores as compared to the precovid period (p>0.05). <h3>Conclusions</h3> While there was no difference in sex hormone levels or scale scores used to assess premature ejaculation, erectile dysfunction, chronic prostatitis, or anxiety, we noticed an unanticipated decrease in depression levels in individuals recovering from COVID-19. More precise results on the impact of COVID-19 on male sexual health could be revealed in future cohort studies with higher case numbers. <h3>Conflicts of Interest</h3> The authors declare no conflict of interest.