Understanding Selective Dorsal Neurectomy for Premature Ejaculation
Selective dorsal neurectomy is a surgical option for treating premature ejaculation (PE) by partially blocking the conduction of the dorsal nerve of the penis. This procedure aims to reduce the sensitivity of the penis, thereby prolonging ejaculation time. It is particularly recommended for patients who have not found relief from other treatments and whose PE significantly impacts their quality of life.
How the Procedure Works
The essential principle of the selective dorsal neurectomy procedure involves excising a portion of the dorsal nerve branches of the penis to decrease sensitivity. This surgery is typically performed under local anesthesia, where the surgeon makes a small incision on the dorsal side of the penis, locates, and selectively cuts some nerve fibers while preserving essential nerve functions. Post-operative touch sensation and erectile function are generally unaffected, although sensitivity is reduced.
Candidates for Surgery
This surgical intervention is suitable for patients suffering from primary premature ejaculation, particularly those whose ejaculatory latency period is less than 1 minute. Additionally, individuals who have not benefited from conservative treatments, such as behavioral therapy or medication, may be considered for this surgery. If PE severely diminishes a patient's quality of life and contributes to psychological stress or relationship issues, surgical options can be explored.
Surgical Techniques
The specific surgical methods include:
- Dorsal nerve transection: Immediate removal of a portion of nerve fibers.
- Partial dorsal nerve resection: Removal while preserving the main nerve trunk.
- Dorsal nerve electrocautery: Utilizing electrocautery technology to block nerve conduction.
The procedure typically lasts between 30 to 60 minutes, with a recovery period of 1 to 2 weeks. During recovery, patients should maintain cleanliness at the incision site and avoid vigorous physical activities.
Effectiveness of the Procedure
Approximately 70%-80% of patients report a significant extension of their ejaculation latency period post-surgery, leading to improved satisfaction in their sexual experiences. However, this procedure is not a permanent fix, as some patients may experience a recurrence of symptoms over time. It is advisable to incorporate behavioral therapy and psychological counseling post-surgery to obtain optimal long-term results.
Risks Associated with Surgery
As with any surgical procedure, selective dorsal neurectomy involves certain risks, including:
- Post-operative infection
- Poor wound healing
- Abnormal penile sensations
Approximately 5%-10% of patients may experience penile numbness or erectile dysfunction. A comprehensive pre-operative assessment is crucial to weigh the pros and cons of the procedure.
Post-Operative Care
Post-surgery, it is essential to maintain local hygiene and avoid intense physical activities for 2 to 4 weeks. Regular follow-ups are necessary to monitor wound healing. If any abnormal pain, fever, or discharge occurs, patients should seek medical attention immediately. It is also crucial to abstain from sexual activities for one month to allow for proper healing.
Conclusion
The selective dorsal neurectomy stands as a viable option for treating premature ejaculation; however, it is not suited for everyone. Prior to the procedure, thorough discussions with a healthcare provider are essential to understand the inherent risks and expected outcomes. Behavioral therapy and psychological training post-surgery remain vital for achieving sustained success. For those grappling with premature ejaculation, exploring conservative treatments such as topical anesthetics, SSRIs, and behavioral therapy should be the first step before considering surgical intervention.