Study On The Value Of Penile Nerve Electrophvsiology In The Diagnosis And Surgical Treatment Of Lifelong Remature Ejacrulation

Objectives:To evaluate the value of penile nerve electrophysiology in the pathogenic diagnosis and surgical treatment of lifelong premature ejaculation(LPE).Methods:This study consists of 3 parts.Part 1:From September 2015 to October 2017,two hundred and twenty-seven patients with LPE admitted to our andrology department were underwent electrophysiological examination of penile nerve.The lantencies of glans penis somatosensory evoked potential(GPSEP),dorsal nerve somatosensory evoked potentials(DNSEP),and penile sympathetic skin response(PSSR)of all cases were recorded.Patients with lantency of GPSEP<40.83ms and/or lantency of GPSEP<39.03ms,and lantency of PSSR?1184.6ms underwent topical application of cream on the penis.Ten minutes later,they urderwent GPSEP and DNSEP examination once again,and the lantencies of GPSEP and DNSEP were recorded and compared with the corresponding numerical values that before the use of cream.Part 2:From September 2015 to October 2017,compound lidocaine cream(hereafter referred briefly to as cream)were given to treat 106 patients with lantency of GPSEP<40.83ms and/or lantency of GPSEP<39.03ms.The useage of cream was topically appling on the penis 10min before sexual intercourse,and cleaned before the insertion of penis.The treatment time was 1 month.Intravaginal ejaculation latency time(IELT),score of premature ejaculation diagnostic tool(PEDT),and score of sexual life satisfaction(SLS)before and after treatment were recorded and compared.The cases who showed remarkable curative effect to the therapy of cream[criterion:IELT?2min,PEDT?8,(SLS2-SLS1)a?2]were selected.Part 3:From September 2015 to October 2017,thirty patients which reacted well to the treatment of cream but pursued further management for intolerance of adverse drug reactions underwent selective dorsal neurectomy(SDN).Patients were allowed to have sexual life 1 month after operations.GPSEP and DNSEP were remeasured at 3 months after operation.IELT,lantencies of GPSEP and DNSEP,score of PEDT and international index of erectile function-5(IIEF-5)before and after operation were recorded and analyzed.Information regarding adverse reactions and complications was obtained throughout the postoperative hospital stay and the post-discharge follow-ups.Results:Part 1:Among 227 patients with LPE,one hundred and six(46.7%)cases have shortened lantencies of GPSEP and/or DNSEP,forty-four(19.4%)cases have shortened lantency of PSSR,thirty-three(14.5%)cases have shortened lantencies of GPSEP and/or DNSEP as well as shortened lantency of PSSR,twenty-six(11.5%)cases have normal lantencies of GPSEP,DNSEP and PSSR,ten(4.4%)cases have shortened lantencies of GPSEP and/or DNSEP as well as non-elicited PSSR;eight(3.5%)cases have normal lantencies of GPSEP and DNSEP as well as non-elicited PSSR.In total,80.6%patients have shortened lantencies of GPSEP,DNSEP and(or)PSSR.The lantencies of GPSEP and DNSEP in patients with shortened lantencies of GPSEP and/or DNSEP were significantly prolonged at 10min after the topical application of cream(P<0.05).Part 2:During the therapeutic process of cream,the mean IELT were significantly prolonged(P<0.05),the mean PEDT score was significantly decreased(P<0.05),and the mean SLS scores of the patient as well as their partners were significantly improved(P<0.05).Among the 106 patients received the treatment of cream,78 cases were effective,with an effective rate of 73.6%.Part 3:Among the 30 patients,IELT was significantly prolonged(means the IELT was more than or equal to 5min)in 12,improved(means the IELT was more than or equal to 2min but less than 5min)in 16 but not improved in 2 case,with a total effective rate of 93.33%.Two cases of preputial edema,2 cases of penile numbness,and 1 case of sexual pleasure decline combined with erectile dysfunction characterized by the diffculty of mainting erection.After surgery,the mean lantencies of GPSEP and DNSEP were significantly prolonged(P<0.05),the mean PEDT score was significantly decreased(P<0.05),and the mean SLS scores of the patient as well as their partners were significantly improved(P<0.05).There was no significant difference between IIEF-5 scores before and after surgery(P>0.05).Conclusions:Penile nerve electrophysiology can classify LPE into 4 types-type of penile hypersensitivity,type of sympathetic hyperexcitability,mixed type,other kinds of types-from the perspective of the etiology.It has great value in LPE diagnosis,most of LPE patients can be found abnormalities in dorsal penile nerve and/or sympathetic nerve.Compound lidocaine cream can prolonged the GPSEP and DNSEP lantency of LPE patients with penile hypersensitivity,effectively increase their IELT,decrease PEDT score and improve SLS of patients as well as their partners.This indicate that decreasing the penile hypersensitivity is an effective method to treating LPE patietns with penile hypersensitivity.Penile nerve electrophysiology can objectively screen out the LPE patients with penile hypersensitivity,and the usage of cream can help to estimate if LPE patients with penile hypersensitivity have other important etiological factors.Penile nerve electrophysiology combined with cream can screen out the LPE patients who have the indications of SDN,the results of penile nerve electrophysiology and the observation of the cream's curative effect should be important reference indexes to judge whether the LPE patients are suitable to SDN.However,there are no effective methods to judge how many the branches of dorsal nerves should be excised.In order to guarantee the safety of SDN,the surgical method uesd at present time may incline to conservative,and the increasement of ILET is limited.SDN is not a mature surgical technique at present,it needs further study,exploration and normalization.SDN is not suitable for clinical promotion at present time.