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Selektif Dorsal Sinir Modülasyonu Ameliyatı Nasıl Yapılır?

Dear patients and valued readers of my website,

In my urology practice, I encounter many different issues related to men's sexual health. Among these, premature ejaculation (PE), which negatively affects both the patient's quality of life and their partner relationships, is a common and critical concern that requires careful attention. For this condition, which I frequently observe in patients visiting my clinic in Adana and the Çukurova region, I successfully apply Selective Dorsal Nerve Modulation (SDN/SDC) surgery as a modern and effective surgical option when traditional treatment methods prove insufficient. In this article, based on my experiences, I would like to explain in detail how this special surgery is performed, who it is applied to, and what to expect.

What is Premature Ejaculation and Why is it Important?

Premature ejaculation is defined as ejaculation occurring with minimal sexual stimulation, usually shortly before or after penetration, sooner than the individual or their partner desires, and causing distress to the individual. International urology guidelines (e.g., EAU - European Association of Urology guidelines) evaluate this condition in conjunction with the individual's lack of control and the resulting negative psychological consequences. In my clinic, I frequently witness the anxiety, lack of self-confidence, and relationship problems caused by this condition in patients coming from Mersin, Hatay, and surrounding provinces. Thoroughly analyzing the patient's condition before starting treatment is the most crucial step for me.

What is Selective Dorsal Nerve Modulation (SDN/SDC)?

Selective Dorsal Nerve Modulation is a microsurgical method I apply in the treatment of premature ejaculation, especially in cases where other methods have been unsuccessful or where penile hypersensitivity is prominent. The primary goal of this surgery is to prolong ejaculation time by reducing the excessive sensitivity of the glans penis. This procedure is based on the principle of selectively cutting a portion of the penile dorsal nerves. The key word here is 'selective'; not all nerves are targeted, but only specific nerve fibers that cause excessive sensitivity. In this way, sexual pleasure and erectile function are preserved, while ejaculatory control is enhanced.

How is the SDN/SDC Procedure Performed?

The Selective Dorsal Nerve Modulation surgery I perform in my clinic requires meticulous preparation and a precise surgical technique:

1. Pre-operative Evaluation

Detailed History and Physical Examination: The patient's sexual history, ejaculation latency, ejaculatory control, general health status, and expectations are thoroughly assessed.

Sensitivity Tests: Penile sensitivity levels are objectively measured with special tests such as penile biothesiometry. These tests provide me with important data on which nerves to target.

Psychological Assessment: If deemed necessary, assessments are made to understand the role of psychological factors in premature ejaculation.

Discussion of Treatment Alternatives: The advantages, disadvantages, and potential risks of behavioral therapies, pharmacological treatments, and SDN/SDC are transparently explained to the patient.

2. Surgical Procedure

Anesthesia: The procedure is usually performed under local anesthesia with sedation or general anesthesia. Patient comfort and safety are my priority.

Incision: A small, aesthetic incision is made just below the glans penis (subcoronal region).

Nerve Identification and Modulation: Dorsal nerves are carefully identified using microsurgical techniques and special magnification (surgical microscope or loupes). Based on the results of pre-operative sensitivity tests and my experience, a certain percentage (typically 30-50%) of these nerves are selectively transected. This ratio is adjusted according to the patient's individual sensitivity.

Closure: The incision is closed with self-dissolving sutures. The surgery typically lasts around 30-60 minutes.

3. Post-operative Care and Recovery

Pain Management: Post-operative pain is usually mild and can be controlled with simple analgesics.

Return to Daily Activities: Patients are usually discharged on the same day and can return to their normal daily activities within a few days.

Sexual Activity: Sexual abstinence is generally recommended for 4-6 weeks for complete healing and nerve adaptation.

Follow-up: The healing process and changes in ejaculation time are closely monitored with regular follow-up appointments.

Who is a Suitable Candidate for SDN/SDC?

This surgery is not suitable for every patient with premature ejaculation. In my clinic, I generally recommend SDN/SDC to patients who meet the following criteria:

Those with severe, lifelong premature ejaculation complaints.

Those who have not benefited from conservative methods such as behavioral therapies and pharmacological treatments, or who cannot continue these treatments due to side effects.

Those with documented hypersensitivity in penile sensitivity tests.

Those who have realistic expectations about the potential benefits and risks of the surgery.

Potential Risks and Side Effects

As with any surgical procedure, SDN/SDC also has some potential risks and side effects. However, thanks to selective nerve transection and microsurgical techniques, these risks are minimized:

Sensitivity Changes: Rarely, permanent numbness or, conversely, excessive sensitivity may occur. However, with correct nerve selection, this risk is quite low.

Infection or Bleeding: These are general risks that can occur with any surgical procedure.

Insufficient Effect or Recurrence: In some patients, the expected effect may not be achieved, or premature ejaculation complaints may recur over time.

In my clinic in Adana, I am proud to offer the most current and scientific approaches to our patients in the Mediterranean region. I strongly advise patients who are struggling with premature ejaculation and whose quality of life is negatively affected to contact me for detailed information about this modern treatment option and a personalized evaluation. Remember, accurate diagnosis and a tailored treatment plan are the keys to successful outcomes.

I wish you healthy days,

Op. Dr. Fettah Tosun
Urology Specialist