Introduction. Premature ejaculation may be classified by cause (secondary or acquired) and duration (primary and lifelong). For secondary PE a specific ethiological treatment is employed. Treatments for lifelong PE include SSRI, PDE5, topical anesthesia as well as a variety of psychogenic drugs. Currently, we are offering a new treatment which interrupts the nervous afferent reflex arc. Material and methods.-Men with premature ejaculation have abnormal autonomic reflex pathways, due to an abnormal status called hypersensitivity. Hypersensitivity is demonstrated through several neurophysiologic tests. By cutting or interrupting the reflex pathway we can delay the reflex response as well as lengthen the response time. Additionally, this procedure can decrease hypersensitivity and extend the ejaculatory latency time. For the past fifteen years we have treated PE through selective neurotomy and have found evidence that supports PE in men is due hypersensitivity and superficial nervous hyperplasia. Our work was divided in: a) Anatomical studies for normal distribution, sensitive penis nerves, (40 young males dead bodies) b) Clinical studies: vibratory threshold to ejaculation, skin sensitivity and neurophysiologic tests: bulbocavernous reflex, bulbocavernous latency time, bulbocavernous evoked potentials, and evoked genitocerebral potentials and c) Medical, sexual, psychological history and physical examination: . If all results are positive for PE we perform a selective neurotomy to verify: a) surgically: Sensitive nervous hyperplasia first. and: interruption of sensitive afferent nervous finally. b).-Clinically: symtomatic improvement and permanently cure, first and a very big neurophysiological tests change, finally. Results.- Since twelve years ago, we have performed 276 plain selective neurotomies, 36 selective neurotomies plus venous ligature, 42 selective neurotomy plus Nesbit procedure to reach a total of 354 surgical procedures. Results were very satisfactory, changing from 3 to 24 minutes for intravaginal ejaculation latency time, except in four, which nervous hyperplasia was recently confirmed .
Conflict of Interest: None disclosed
Financial Support/Funding: None disclosed
Recorded: Sydney, Australia, April 2007
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