(376) A Retrospective Study of Selective Dorsal Neurectomy for Lifelong Premature Ejaculation: Functional Gains, Sensory Correlation, and Safety Evaluation

Introduction Lifelong premature ejaculation (PE) is a common male sexual dysfunction, often resistant to pharmacologic and behavioral therapies. While selective dorsal neurectomy (SDN) is practiced in select regions, it remains controversial due to limited data on safety and efficacy. This study investigates the clinical impact of SDN in patients with lifelong PE unresponsive to conservative management. Objective To evaluate the functional outcomes, sensory modulation, and safety profile of selective dorsal neurectomy in men with lifelong PE. Methods This retrospective cohort study included 82 men with lifelong PE who underwent SDN between January and October 2024. Inclusion criteria required confirmed lifelong PE, pharmacologic treatment failure, and evidence of penile hypersensitivity (biothesiometric threshold <4V). SDN was performed with a nerve-sparing technique, preserving at least one dorsal penile nerve <1 mm per anatomical zone. Outcomes included changes in intravaginal ejaculatory latency time (IELT), Premature Ejaculation Diagnostic Tool (PEDT) scores, International Index of Erectile Function-5 (IIEF-5), and biothesiometry measurements. Assessments were conducted preoperatively and at 1, 3, and 6 months postoperatively. Statistical analyses included the Wilcoxon signed-rank and Spearman correlation tests. Results Mean IELT increased by 241 ± 134 seconds (559.1%, p < 0.001) at 6 months. PEDT scores decreased by 6.9 ± 1.6 points (48%, p < 0.001), while IIEF-5 scores improved by 1.5 ± 0.7 points (6.6%, p < 0.001). A strong inverse correlation was found between baseline penile sensitivity and postoperative sensory gain (Spearman r = −0.83 to −0.70, p < 0.001), but not with functional improvements. No major complications, including glans numbness or anorgasmia, were reported. Conclusions Selective dorsal neurectomy appears to be a safe and effective treatment for lifelong PE in appropriately selected patients. The procedure significantly improves ejaculatory control while preserving erectile function and minimizing complications when performed using a nerve-preserving approach. Further long-term, controlled studies are warranted to validate these findings and optimize surgical protocols. Disclosure No