| Objective: To evaluate the significance of penile nerve electrophysiological examination for accurate diagnosis and treatment options of primary premature ejaculation(PPE).Methods: 279 PPE patients were included in the outpatient department of andrology from July 2017 to October 2019,including 68 patients who had undergone circumcision and 211 patients who had not undergone circumcision.Part 1: the 279 PPE patients were examined penile nerve electrophysiological,and recorded the penile somatosensory threshold,the latency of dorsal nerve somatosensory evoked potential(DNSEP),the penile head biosensory threshold,the latency of somatosensory evoked potential of glans penis(GPSEP)and the latency of penile sympathetic skin response(PSSR).Based on relevant literature,these PPE patients were classified into four types according to the test results: namely penile hypersensitivity(DNSEP and/or GPSEP latencies shortened while PSSR latencies were normal),sympathetic central hyperexcitability(both DNSEP and GPSEP latencies were normal and PSSR latencies shortened),mixed type(DNSEP latencies and/or GPSEP latencies shortened and PSSR latencies shortened),and neuroelectrophysiological normal(DNSEP,GPSEP and PSSR latencies were normal).Then analyzed the results.Part 2: The penis head and penis body surface of the above 279 patients with PPE were given compound lidocaine cream(anesthetic group),and10 minutes later the penile nerve electrophysiology was remeasured.The penile body sensory threshold,the latency of DNSEP,the penile head sensory threshold,and the latency of GPSEP were recorded respectively,and compared with the data before topical anesthesia.Part 3: Selecting patients from the first part with highly sensitive penis and conformed to the surgical indications for selective dorsal neurectomy(SDN)(Chinese guidelines and expert consensus for diagnosis and treatment of andrology diseases 2016 edition).Then the 21 selected patients accepted SDN under microscope.Recording the intravaginal ejaculation latency time(IELT),premature ejaculation diagnostic tool(PEDT)and international erectile function questionnaire-5(IIEF-5)3 months after operation,observing and recording the occurrence of postoperative complications.Results: Part 1: Among 279 PPE patients,146(52.3%)were penile hypersensitivity,58(20.8%)were sympathetic central hyperexcitability,44(15.8%)were mixed type,and 31(11.1%)were neuroelectrophysiological normal.The penile hypersensitivity type,sympathetic center exhilaration type and mixed type accounted for 88.9% of all subjects.In 279 PPE patients,the penile body biosensory threshold(2.41 ± 0.90 m A)was higher than that of the penile head(2.10 ± 0.89 m A)(P < 0.05).In patients with PPE,the latency of DNSEP with circumcision was slightly longer than that of DNSEP without surgery(P> 0.05),while the latency of GPSEP with circumcision was significantly longer than that without surgery(P <0.01).Part 2: The penile biosensory threshold of 279 PPE patients with topical anesthesia was significantly higher than that before anesthesia(P < 0.01),the difference was statistically significant.The latency of DNSEP and GPSEP with topical anesthesia was slightly longer than that before anesthesia(P > 0.05),but there was no statistically significant difference.Part 3: The total effective rate was 95.24% in 21 PPE patients who underwent microscopic SDN,including 12 cases(57.14%)significantly effective,8 cases(38.10%)effective,and 1 case(4.76%)ineffective.There were 3 cases of prepuce edema and 1 case of numbness of penile head after operation.Postoperative IELT(7.87 ± 5.03min)was significantly longer than preoperative IELT(0.51 ± 0.20 min),P < 0.01,the difference was statistically significant.Postoperative PEDT(4.48 ± 2.20)was significantly lower than preoperative PEDT(15.29 ± 1.93),P < 0.01,the difference was statistically significant.There was no significant change in IIEF-5 score before and after surgery(P > 0.05).Conclusion: PPE classification according to penile nerve electrophysiology is a more precise and objective diagnostic method based on etiology,which makes up for the shortcomings of the existing classification of premature ejaculation(PE)to some extent,and provides an objective basis for the selection of treatment options.Increased penile sensitivity and/or increased excitability of sympathetic centers are two pathogenic factors in most patients with PPE.The latency of GPSEP in patients with PPE was significantly longer than that of GPSEP without surgery.It is considered to be related to some susceptor or afferent nerve injury during operation and scar formation after surgery.That is,the GPSEP latency of PPE patients who had undergone circumcision cannot be used as evidence to judge penile sensitivity.The penile sensory threshold increased significantly after topical anesthesia,which further verified from objective data that the mechanism of topical anesthesia in the treatment of PE was to improve the penile sensory threshold and decrease the penile sensitivity,thereby prolonging IELT and improving the symptoms of premature ejaculation.However,the latency of DNSEP and GPSEP after topical anesthesia was not significantly prolonged compared with that before anesthesia,which indicates that the influence of somatosensory evoked potential(SEP)latency and penile sensation threshold on ejaculation time has different mechanisms,and further exploration is needed in the future.The efficacy of SDN performed after neuroelectrophysiological examination and topical anesthetic treatment screening is significantly higher than that of SDN that has not been selected by neuroelectrophysiological evaluation,which suggests that the penile neurophysiology has guiding significance for the accurate diagnosis and classification,surgical indications and the treatment options of PPE.This study found that the penile nerve electrophysiological examination has good application prospects in the precise diagnosis and classification of PPE and the selection of treatment options,but large samples and prospective research are still needed. |
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