Value Of Penile Nerve Electrophysiology In The Treat Of Premature Ejaculation

Objective:To observe and evaluate the value and efficiency of penile nerve electrophysiology in premature ejaculation.Methods:Part 1:123 patients admitted to our department from February 2013 to February 2014 were underwent DNSEP、GPSEP and PSSR examination. The latencies and amplitudes of DNSEP/GPSEP and PSSR were recorded among all the subjects.Part 2:penile dorsal nerve neurotomy was performed in 25 patients (latency of DNSEP less than 40.83s) admitted to our department from October 2012 to December 2013.One month after operation, the patients could have sexual life.Three months after operation, the latencies and amplitudes of GPSEP/DNSEP were measured. The patients were followed up for 3 months, during which ejaculation latency and CIPE-5 were recorded and evaluated. Meanwhile adverse reactions at the incision were observed. Part 3:Sertraline (50mg/d) were taken for two months in 54 patients (latency of DNSEP/GPSEP more than 40.83ms, latency of PSSR less than 1184.6ms) admitted to our department from April 2013 to January 2014. After having sertraline for otwo months,the patients were evaluated for PSSR tests, and sexual parameters including the ejaculation latency and the Chinese premature ejaculation index-5 and International Index of Erectile Function-5, were collected through a questionnaire survey and analyzed。Results:Part 1:There were 23 patients (latency of PSSR less than 1184.6ms)、 69 patients (latency of DNSEP/GPSEP less than 40.83ms)、18 patients (latency of PSSR less than 1184.6ms and latency of DNSEP/GPSEP less than 40.83ms) and 13 patients (latency of PSSR more than 1184.6ms and latency of DNSEP/GPSEP more than 40.83ms).Part 2:In the operation group, the ejaculation latency was significantly prolonged in 10, improved in 13 but not improved in 2 patients, with a total effective rate of 92.00%. One case of penis numb and two cases of foreskin edema were observed during the follow-up.After operation, CIPE-5 in patients had been significantly improved (P<0.05), and mean latencies of GPSEP and DNSEP were significantly longer (P<0.05), mean amplitude of GRSEP was significantly lower (P<0.05), but mean amplitude of DNSEP had no significant difference. Part 3:In the sertraline group,54 patients completed the entire study and were analyzed.After the two months sertraline treatment, compared with those of pre-treatment, IELT and CIPE-5 in patients had been significantly improved (P<0.05). And mean amplitude of PSSR was significantly lower (P<0.05),and mean latency of PSSR was significantly prolonged (P<0.05).2 cases of nausea,2 cases of thirst,1 cases of insomnia, and 2 case of constipation were observed during the follow-up.Conclusion:Penile dorsal nerve neurotomy can effectively reduce the sensibility of penis, prolong ejaculation latency and improve the CIPE-5.Premature ejaculation with penile hypersensitivity can be identified through penile nerve electrophysiology. It provides a screening method for the treatment of premature ejaculation.These results suggest that clinical improvement in response to sertraline in the PPE patients, at least in part, is mediated through reducing sympathetic nervous system activity indexed by PSSR.Measurement of the PSSR appears to provide useful information for predicting treatment responses in the PPE patients.