(375) Bulbospongiosus Muscles Cutting With Frenular Delta Excision and Neurectomy for Treatment of Premature Ejaculation (Alaa Aglan5) Operation

Introduction Alaa Aglan (5) operation consists of bulbospongiosus muscles cutting bilaterally (fig 1), frenular delta excision (fig 2) and selective neurectomy at ventral and dorsal aspects of penis (fig 3). The cutting of bulbospongiosus muscles bilaterally inhibits the expulsion phase of ejaculation, excision of frenular delta decrease the number of receptors in anterior third of ventral aspect of penis so increase the time needed to reach maximum arousal. Selective neurectomy is very effective especially in primary premature ejaculation. The prediction tests reveals the possible side effects and if the operation is indicated or not. It is a group of tests applied in different Alaa Aglan operations, in this operation we spray local anesthesia ( procomail®) at coronal ridge ( inhibits - glans – bulbospongiosus reflex and on anterior third of ventral aspect of penis. Anesthetize receptors in frenular delta area, the ventro - lateral branches of dorsal nerves and terminal branches of perineal nerves. And local injection of xyocaine 10% around chosen nerve/s. prediction test means clinically patient selection. In our early trials Alaa Aglan(5) operation satisfaction rate was 71% (without prediction test). It is strong operation if any patient was not satisfied by the result of any operation either (Alaa Aglan, 2, 3, 4) or other operations. Alaa Aglan(5) operation was considered the operation of choice for magnification of the ejaculation time (prediction tests were not done at that time) if prediction tests was not satisfactory we can use alpha blockers ( Cardura 2mg) or ( clomipramine 25 mg) before doing the test if the response was good that means the patient will need operation and drug therapy after that ( synergetic action). Objective Presentation of new operation for treatment of premature ejaculation permanently (Alaa Aglan5). Methods Study was done between (5/2/2012 – 9/7/2017), 332 patients we operated. Bulbospongiosus muscles were cut bilaterally, frenular delta excision, selective neurectomy to dorsal nerves one side of penis and the ventro – lateral branches at the opposite side (at middle third of shaft before branching). Results All patients showed great improvement in ejaculation time (due to prediction test). 6 cases reported mild penis, one case reported wound dehiscence both treated by dressing, 3 patients reported neuroma treated medically, one patient (blind) used clomipramine 25 mg post-surgery, the time was increased from several seconds to 7 minutes (after years of failure of medical treatment), one patient used Cardura 2 mg post-surgery and the time increased greatly both drugs seems to affect emission phase strongly (prostatic emission or seminal vesicles emission) further studies are needed to clarify this point. Conclusions Alaa Aglan(5) operation is very effective, potent, permanent solution and is recommended if prediction test was promising. Disclosure No