Selective Dorsal Crioablation for Premature Ejaculation (SDC, PE) is an emerging, minimally invasive procedure aimed at prolonging ejaculation latency by selectively ablating the dorsal penile nerves using cryotherapy. This technique targets nerve sensitivity reduction while preserving erectile function, offering a potential long-term solution for individuals struggling with premature ejaculation (PE).

What is selective dorsal crioablation for PE?

Selective Dorsal Crioablation for Premature Ejaculation is a minimally invasive procedure that uses cryotherapy to selectively target and reduce the sensitivity of the dorsal penile nerves. By carefully applying controlled freezing temperatures to these nerves, the procedure aims to delay ejaculation, offering a potential long-term solution for men who experience premature ejaculation. This technique focuses on reducing nerve activity without significantly compromising erectile function, making it an emerging alternative for patients who have not found success with conventional treatments.

Mechanisms of selective dorsal crioablation for PE

Selective dorsal crioablation works by targeting the dorsal penile nerve, which plays a key role in penile sensitivity and ejaculation control. The procedure involves the following steps:

• Identification of the Dorsal Penile Nerve: Using ultrasound or nerve mapping, the precise location of the nerve branches responsible for heightened sensitivity is determined.
• Cryoablation Application: A cryoprobe is used to deliver controlled freezing temperatures (-40°C to -60°C) to selectively ablate overactive nerve fibers, reducing their ability to transmit excessive sensory signals.
• Nerve Desensitization: The freezing process temporarily or permanently disrupts nerve conduction, leading to reduced penile hypersensitivity. This helps increase ejaculatory latency without significantly affecting erectile function.
• Gradual Nerve Regeneration: Depending on the extent of the ablation, partial nerve regeneration may occur over time, potentially allowing for adjustments or repeated treatments if necessary.

By selectively targeting nerve fibers involved in premature ejaculation, this technique offers a minimally invasive alternative to traditional treatments, aiming for long-lasting improvement with fewer systemic side effects.

How to perform selective dorsal crioablation?

Selective dorsal crioablation is a minimally invasive procedure designed to reduce penile sensitivity and prolong ejaculation latency. It is typically performed under local anesthesia in an outpatient setting.

Preoperative Preparation

• Patient Evaluation: Assess ejaculation latency, penile sensitivity, and rule out underlying conditions.
• Ultrasound/Nerve Mapping: Identify the dorsal penile nerve branches to ensure precise targeting.
• Anesthesia: Apply local anesthesia (e.g., lidocaine) at the dorsal penile base to minimize discomfort.

Cryoablation Procedure

• Insertion of Cryoprobe: A thin cryoablation probe (2–3 mm in diameter) is inserted percutaneously near the identified nerve branches.
• Cooling Process: The probe delivers controlled freezing temperatures (-40°C to -60°C) using liquid nitrogen or argon gas.
• Freezing-Thawing Cycle: Typically, a freeze-thaw-freeze cycle is performed to ensure effective nerve ablation.
• Monitoring: Temperature sensors confirm optimal cooling while minimizing damage to surrounding tissues.

Postoperative Care & Recovery

• Compression & Bandaging: Light dressing is applied to reduce swelling.
• Pain Management: NSAIDs or mild analgesics may be prescribed for post-procedure discomfort.
• Activity Restrictions: Patients should avoid sexual activity for 2–4 weeks to allow proper healing.
• Follow-Up: A reassessment is done in 4–6 weeks to evaluate sensitivity reduction and ejaculatory control.

Advantages of SDC

This technique represents a promising non-pharmacological approach for patients with persistent premature ejaculation, offering long-term benefits with minimal invasiveness.

• Increased Ejaculatory Latency: Most patients experience a significant delay in ejaculation without major erectile dysfunction.
• Potential for Nerve Regeneration: In some cases, sensitivity may gradually return over months to years, allowing for repeat treatments if necessary.
• Minimal Side Effects: Compared to surgical neurectomy, cryoablation preserves more nerve function, reducing the risk of permanent numbness.

How long SDC for PE is effective, is it reversable, repeatable?

Overall, selective dorsal crioablation offers a balance of long-lasting effects with the flexibility of reversibility and repeatability, making it a promising option for managing premature ejaculation.

Effectiveness Duration:

• The effects of selective dorsal crioablation typically last from several months to a few years.
• Individual outcomes vary; some patients experience prolonged benefits, while others might notice a gradual return of sensitivity as nerves regenerate.

Reversibility:

• The procedure is designed to be reversible.
• Nerve regeneration can lead to the gradual return of sensitivity over time, allowing the effects to diminish if desired.

Repeatability:

• Given its minimally invasive nature and the potential for nerve regeneration, the procedure can be repeated.
• Repeat treatments may be considered if the benefits wane or if symptoms of premature ejaculation recur.

Success of SDC for PE

Selective dorsal crioablation is an experimental and minimally invasive technique that aims to prolong intravaginal ejaculatory latency time (IELT) by reducing penile hypersensitivity. While still under clinical evaluation, preliminary studies and case reports suggest promising outcomes.

Clinical Effectiveness:

• Studies and early clinical reports suggest significant improvement in intravaginal ejaculatory latency time (IELT). Many patients experience a 2x to 5x increase in IELT post-procedure. Improvements are typically noticeable within weeks and can last months to years, depending on nerve regeneration.
• Early clinical reports suggest that over 70% of patients are satisfied with their improvement.
• Some may require a repeat procedure if sensitivity gradually returns due to nerve regeneration.

• Patients generally experience 2–5 times prolongation in ejaculation latency compared to baseline.
• Sensory reduction is typically partial, preserving normal erectile function and pleasurable sensations.

Long-Term Outcomes:

• Many patients report sustained benefits for 6 months to several years after the procedure.
• Some degree of nerve regeneration may occur over time, potentially requiring repeat treatments.

Patient Satisfaction:

• High satisfaction rates due to minimally invasive nature and lack of systemic side effects compared to medications.
• Patients with severe hypersensitivity-related premature ejaculation show the best response.

Overall, Selective Dorsal Crioablation appears to be a promising alternative to medications and surgical neurectomy, offering long-lasting results with minimal complications.

Complications

While selective dorsal crioablation is considered a minimally invasive procedure with a favorable safety profile, several potential complications may occur:

• Temporary Numbness or Altered Sensation: Some patients may experience numbness or reduced sensitivity in the treated area, which is often temporary but could, in rare cases, persist longer than expected.
  • Pain or Discomfort: Mild to moderate pain at the treatment site is common post-procedure. This discomfort is typically managed with over-the-counter pain relievers.
  • Edema and Swelling: Local swelling or edema can occur due to the inflammatory response following the cryoablation. This usually subsides within a few days to weeks.
  • Hematoma or Bruising: The insertion of the cryoprobe may lead to bruising or the formation of a small hematoma at the site of treatment.
  • Infection: As with any invasive procedure, there is a risk of infection at the puncture site. Adhering to sterile technique and proper post-procedure care helps minimize this risk.
  • Over-Ablation Leading to Excessive Desensitization: If the ablation is too extensive, patients might experience a decrease in sexual pleasure or difficulty achieving orgasm.
  • Potential Impact on Erectile Function: Although the procedure is designed to preserve erectile function, inadvertent damage to surrounding nerves may, in rare cases, affect erectile quality.
  • Scar Tissue Formation: There is a possibility of scar tissue development at the ablation site, which could potentially alter nerve regeneration dynamics.

Each of these complications is generally rare and can often be managed effectively with prompt medical intervention and careful procedural technique. Patients should have a detailed discussion with their healthcare provider about the risks and benefits before undergoing the procedure.

Summary

While Selective Dorsal Crioablation shows promising success rates, it remains an evolving technique with ongoing research. For patients with severe PE unresponsive to medication, it could be a viable long-term option with fewer side effects than surgical

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE