Premature ejaculation: surgical treatment and its impact on reproductive function

Vollständiger Abstract

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Introduction. Sexual dysfunctions, including erectile dysfunction and ejaculatory disorders, are highly prevalent among men and can adversely affect reproductive potential, making timely diagnosis and effective treatment essential. Objective. To evaluate the efficacy of surgical treatment for premature ejaculation and its impact on reproductive function. Materials & methods. The study included 116 men with premature ejaculation who expressed a strong desire to preserve and realise their reproductive potential. The diagnosis was based on the International Society for Sexual Medicine criteria. Patients underwent a comprehensive evaluation to determine the form of premature ejaculation and the main aetiological factor, including examination of the external genitalia, digital rectal examination, lidocaine test, hormonal assessment (serum testosterone, estradiol, luteinising hormone, follicle-stimulating hormone, prolactin, thyroid-stimulating hormone, triiodothyronine, and thyroxine), bacteriological testing and real-time PCR of the ejaculate and prostatic secretion, microscopy of prostatic secretion, as well as ultrasound of the scrotal organs and transrectal ultrasound of the prostate and seminal vesicles. Selective microsurgical denervation of the penile glans was performed in 41 patients. Results. Three months after denervation, 34 patients (82.9%) achieved an average vaginal intercourse duration of more than 2 minutes. Thus, in most patients, surgery made it possible to establish spontaneous regular sexual activity with a satisfactory duration of intercourse. No significant differences were found between preoperative and postoperative semen parameters. Conclusion. Selective microsurgical denervation of the penile glans enables patients with primary premature ejaculation to achieve regular sexual activity while avoiding treatment methods that prevent or reduce the likelihood of natural conception.