Selective neurotomy
Through a subcoronal incision (as in circumcision), the skin is shifted to the base, and the dorsal neurovascular bundle is exposed under magnifying glasses. Of the 4–8 branches of the dorsal nerve, approximately half are crossed or excised, symmetrically on both sides, the main trunks and arteries are preserved - this way the density of the sensory fibers of the head is reduced without its complete denervation. The skin returns to its place; in case of excess foreskin, the operation is combined with circumcision. The head is numb for the first weeks, sensitivity returns to a new level in 2-3 months, after which the result is assessed.
Place of surgery in treatment
Premature ejaculation is treated primarily conservatively: behavioral techniques, local anesthetics, dapoxetine and other drugs, treatment of prostatitis. Selective denervation is considered in the primary form with increased sensitivity of the head, when conservative methods are ineffective or unacceptable. The operation reduces excess afferentation, prolonging sexual intercourse by 2–5 times in 60–80% of patients; The sensitivity of the head is partially preserved, orgasm does not suffer.
Risks
Temporary numbness of the head is possible (usually disappears in 2-3 months as regeneration occurs), rarely - a persistent decrease in sensitivity or insufficient effect. The operation is performed by andrologists with experience in microsurgery, preserving the main nerve trunks; Sexual activity resumes after 4–6 weeks.
