Presented by: Yakov Mirkin
URO-PRO Clinics

Introduction

Premature (early) ejaculation is the second most common type of male sexual dysfunction, which has significant negative impact on the quality of life. Nowadays there is no satisfactory treatment for premature ejaculation despite its obvious need. Conservative therapy for premature ejaculation is based on the sensory decrement of the glans penis with topical anesthetics. Pharmacological effects on serotonin receptors of the central nervous system are also used with selective serotonin reuptake inhibitors. Surgical methods of treatment are based on sensory decrement of the glans penis by various methods, the main of which for the moment is selective dorsal neurotomy. The method has demonstrated good efficacy; however, it is invasive and is accompanied by the risk of complications, also the result of the intervention is not predictable. Recently, minimally invasive methods have been developed to reduce excessive sensitivity of the glans penis by temporary demyelination of the dorsal nerve of the penis using radiofrequency or cryoablation. This abstract presents the results of selective minimally invasive cryoablation of the penile nerves as a treatment for premature ejaculation.

Materials

The retrospective study included 28 patients aged 22 to 35 years (mean age 28.7 years). All patients met CriPE (Criteria for Premature Ejaculation). The median Intravaginal Ejaculation Latency Time was 75.8 seconds (range 25 to 118 seconds). Patients completed the Premature Ejaculation Profile with a mean score of 3.6 (range 0 to 6) indicating extremely poor ejaculation control, high levels of distress, and an apparent negative impact on relationships with sexual partners. All participants underwent selective minimally invasive cryoablation of the dorsal nerves of the penis.Method for prersize localization of penile nerves was electrical stimulation at a frequency of 50 - 100 Hz, which causes paresthesias in the region of innervation of the penile sensory nerves.With electrical stimulation of the dorsal nerve of the penis, paresthesias (tingling, etc.) appear in the region of the glans penis. The cryoablation device has a built-in electrical stimulator. Cryoablation of the dorsal nerves of the penis is currently performed under electrical stimulation navigation and is as follows: 

1. Local anesthesia of the skin with 0.5 cc 1% lidocaine solution

2. Penetration of the cannula for intravenous injection of 14G through the skin into the region of the dorsal neurovascular bundle at the 2 o'clock position – perpendicularly axis of the penis.

3. Insertion the isolated cryoprobe 18 G through the cannula.

4. Electrical stimulation with a frequency of 50 Hz to find the dorsal nerve

5. After localization of the nerve (the cryoprobe is located in the zone of maximum sensory response to stimulation), an additional anesthetic portion of 1 ml is injected through the cannula port

6. Nerve freezing: 2 freeze cycles with 2 minutes exposure and 1 minute defrost time

7. Repetition of points 4 - 6 in the position at 11 o'clock.

   Three months after the procedure, participants filled the Premature Ejaculation Profile again and measured their Intravaginal Ejaculation Latency Time.

Results

,

Average Intravaginal Ejaculation Latency Time increased from of 75.8 seconds to 227.6 seconds (+298%), the average Premature Ejaculation Profile score increased from 3.6 to 11.35 points (+315%). No significant complications were recorded.

Conclusion

Selective minimally invasive cryoablation is a promising treatment  for premature ejaculation in patients who have positive response with topical anesthetics. However, additional studies with a larger number of participants are recommended.

Funding

No conflict of interest