A Retrospective Study of Selective Dorsal Neurectomy for Lifelong Premature Ejaculation: Erectile and Ejaculatory Functions, Sensory Correlation, and Safety Evaluation

Introduction Premature ejaculation (PE) is a common male sexual dysfunction and a subset of patients with lifelong PE remain unresponsive to pharmacologic and behavioral therapies. Although selective dorsal neurectomy (SDN) is practiced in certain regions, its safety and efficacy remain underexplored in Western guidelines. Objective The main aim of this study is to evaluate the clinical outcomes, sensory changes, and safety profile of SDN in patients with lifelong PE who failed conventional treatments. Methods In this retrospective cohort study, we reviewed 82 patients with lifelong PE who underwent SDN between January and October 2024. Patients were selected based on strict clinical criteria, including failed response to medical therapy and evidence of penile hypersensitivity, which was objectively assessed using a biothesiometer. SDN involved preserving at least one dorsal penile nerve <1 mm in each of the three anatomical zones. Pre and postoperative assessments included intravaginal ejaculatory latency time (IELT), the International Index of Erectile Function‐5 (IIEF‐5), the PE diagnostic tool (PEDT), and biothesiometry scores. Results At 6 months postoperatively, mean IELT increased by 241.04 ± 134.02 s (559.12%, p < 0.001), PEDT scores decreased by 6.98 ± 1.66 points (48.07%, p < 0.001), and IIEF‐5 improved by 1.51 ± 0.79 points (6.63%, p < 0.001). A strong negative correlation was observed between preoperative sensory thresholds and postoperative improvement in sensory thresholds (Spearman r = −0.83 to −0.70, all p < 0.001). No major complications, including glans numbness or anorgasmia, were reported. Conclusion SDN appears to be a safe and effective surgical option for selected patients with lifelong PE who are unresponsive to conservative treatments. The procedure resulted in significant improvements in ejaculatory control with minimal risk when performed using a nerve‐preserving approach.