A retrospective study of selective dorsal neurectomy for lifelong premature ejaculation: erectile and ejaculatory functions, sensory correlation, and safety evaluation

Abstract

Introduction: Premature ejaculation (PE) is a common male sexual dysfunction and a subset of patients with lifelong PE remainunresponsive to pharmacologic and behavioral therapies. Although selective dorsal neurectomy (SDN) is practiced in certainregions, its safety and efficacy remain underexplored in Western guidelines.Objective: The main aim of this study is to evaluate the clinical outcomes, sensory changes, and safety profile of SDN in patientswith lifelong PE who failed conventional treatments.Methods: In this retrospective cohort study, we reviewed 82 patients with lifelong PE who underwent SDN between January andOctober 2024. Patients were selected based on strict clinical criteria, including failed response to medical therapy and evidence ofpenile hypersensitivity, which was objectively assessed using a biothesiometer. SDN involved preserving at least one dorsal penilenerve <1 mm in each of the three anatomical zones. Pre and postoperative assessments included intravaginal ejaculatory latencytime (IELT), the International Index of Erectile Function-5 (IIEF-5), the PE diagnostic tool (PEDT), and biothesiometry scores.Results: At 6 months postoperatively, mean IELT increased by 241.04 Æ 134.02 s (559.12%, p <0:001), PEDT scores decreased by6.98 Æ 1.66 points (48.07%, p <0:001), and IIEF-5 improved by 1.51 Æ 0.79 points (6.63%, p <0:001). A strong negative correlationwas observed between preoperative sensory thresholds and postoperative improvement in sensory thresholds (Spearman r = −0.83to −0.70, all p <0:001). No major complications, including glans numbness or anorgasmia, were reported.Conclusion: SDN appears to be a safe and effective surgical option for selected patients with lifelong PE who are unresponsive toconservative treatments. The procedure resulted in significant improvements in ejaculatory control with minimal risk whenperformed using a nerve-preserving approach.