Kim J J, Kwak T I, Jeon B G, Cheon J, Moon D G
Department of Urology, Korea University College of Medicine, Sungbuk-ku, Seoul, Korea.
Int J Impot Res. 2004 Dec;16(6):547-51. doi: 10.1038/sj.ijir.3901226.
The main limitation of medical treatment for premature ejaculation is recurrence after withdrawal of medication. We evaluated the effect of glans penis augmentation using injectable hyaluronic acid (HA) gel for the treatment of premature ejaculation via blocking accessibility of tactile stimuli to nerve receptors. In 139 patients of premature ejaculation, dorsal neurectomy (Group I, n=25), dorsal neurectomy with glandular augmentation (Group II, n=49) and glandular augmentation (Group III, n=65) were carried out, respectively. Two branches of dorsal nerve preserving that of midline were cut at 2 cm proximal to coronal sulcus. For glandular augmentation, 2 cc of HA was injected into the glans penis, subcutaneously. At 6 months after each procedure, changes of glandular circumference were measured by tapeline in Groups II and III. In each groups, ejaculation time, patient's satisfaction and partner's satisfaction were also assessed. There was no significant difference in preoperative ejaculation time among three groups. Preoperative ejaculation times were 89.2+/-40.29, 101.54+/-59.42 and 96.5+/-52.32 s in Groups I, II and III, respectively. Postoperative ejaculation times were significantly increased to 235.6+/-58.6, 324.24+/-107.58 and 281.9+/-93.2 s in Groups I, II and III, respectively (P<0.01). The percentage of postoperative satisfaction in both patient and his partner was 68% (17/25) and 44% (7/16) in Group I, 80% (39/49) and 66% (25/38) in Group II and 75% (49/65) and 62% (32/52) in Group III, respectively. Maximal glandular girth was significantly increased from 9.16+/-0.59 to 10.95+/-0.4 cm in Group II and 8.95+/-0.54 to 11.67+/-0.71 cm in Group III, respectively. These results suggest that glandular augmentation with injectable HA gel is a safe and effective modality to reduce sensory of glans penis. Long-term follow-up for residual volume and efficacy should be requested to establish its precise therapeutic potentials in premature ejaculation.
早泄药物治疗的主要局限性在于停药后复发。我们评估了使用可注射透明质酸（HA）凝胶进行阴茎头增大术通过阻断触觉刺激对神经受体的可及性来治疗早泄的效果。对139例早泄患者分别进行了背神经切除术（I组，n = 25）、背神经切除术联合阴茎头增大术（II组，n = 49）和阴茎头增大术（III组，n = 65）。保留中线的两条背神经分支在冠状沟近端2 cm处切断。对于阴茎头增大术，将2 cc的HA皮下注射到阴茎头内。在每次手术后6个月，用卷尺测量II组和III组阴茎头周长的变化。在每组中，还评估了射精时间、患者满意度和性伴侣满意度。三组术前射精时间无显著差异。I组、II组和III组术前射精时间分别为89.2±40.29、101.54±59.42和96.5±52.32秒。术后射精时间在I组、II组和III组分别显著增加至235.6±58.6、324.24±107.58和281.9±93.2秒（P<0.01）。I组患者及其性伴侣术后满意度百分比分别为68%（17/25）和44%（7/16），II组分别为80%（39/49）和66%（25/38），III组分别为75%（49/65）和62%（32/52）。II组阴茎头最大周长从9.16±0.59显著增加到10.95±0.4 cm，III组从8.95±0.54显著增加到11.67±0.71 cm。这些结果表明，可注射HA凝胶进行阴茎头增大术是一种安全有效的减少阴茎头感觉的方法。需要对残余量和疗效进行长期随访，以确定其在早泄治疗中的精确治疗潜力。
