(123) Effectiveness of Posterior Tibial Nerve Stimulation (PTNS) Therapy for Premature Ejaculation: A Propensity Score Matching Analysis

Introduction Several studies suggest that posterior tibial nerve stimulation (PTNS) may modulate the ejaculatory reflex, increasing ejaculatory latency time in men with premature ejaculation (PE). However, the effect of adding this therapy to pharmacological treatment in men with PE remains unclear. Objective To evaluate the effectiveness of adding PTNS therapy to pharmacological management for PE, compared with pharmacological treatment alone. Methods We conducted a retrospective observational cohort study. Men diagnosed with PE and treated between 2021 and 2023 were included in the study. For the PTNS group, patients must have received at least 12 sessions of PTNS therapy and paroxetine or paroxetine plus tadalafil. ENTP therapy consisted of thirty-six 30-minute sessions, three sessions per week. The control group included patients who received pharmacological treatment only. Propensity score matching was performed at a 2:1 ratio based on age, baseline intravaginal ejaculation latency time (IELT), and Premature Ejaculation Diagnostic Tool (PEDT) score to ensure comparability between groups. Changes in IELT and PEDT score at three months after treatment initiation were compared between groups. A multivariate analysis was conducted, including the use of topical anesthetics and psychosexual therapy as covariates. Results A total of 212 patients in the PTNS group and 341 in the control group were included in the analysis. Baseline clinical characteristics were similar between groups, except for the proportion of patients who attended at least one session of psychosexual therapy (17.5% in the PTNS group vs. 5% in controls). Among patients receiving PTNS, the median number of sessions was 36 (range 12–63), and 75.9% completed the full 36-session protocol. At three months after treatment initiation, 70.8% of patients treated with PTNS plus medication achieved a threefold increase in IELT, compared with 55.1% of those treated with medication alone (p<0.001). The median IELT was 300 seconds in the PTNS group and 180 seconds in the control group (p<0.001). The median fold increase in IELT was 4 in the PTNS group compared to 3 in controls (p<0.001). Additionally, 67% of patients in the PTNS group achieved a final PEDT score <9, compared with 15% in the control group (p<0.001). Multivariate analysis showed no effect modification by topical anesthetic use or attending more than two psychosexual therapy sessions. Thirty-eight adverse events were reported, only one of which was related to PTNS (tingling at the electrode site) and resolved without complications; all other events were associated with pharmacological treatment. Conclusions Our results suggest that the combination of PTNS with pharmacological treatment is more effective than pharmacological therapy alone for the management of premature ejaculation, without additional adverse effects. Prospective studies with more robust methodologies are needed to confirm this hypothesis. Disclosure Yes, this is sponsored by industry/sponsor: Boston Medical Group Clarification: Industry funding only - investigator initiated and executed study Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Medical Group