What is Selective Dorsal Nerve Modulation?
Selective dorsal nerve modulation (microsurgical dorsal neurectomy) is a surgical procedure performed for cases of primary (lifelong) premature ejaculation caused by hypersensitivity of the glans penis. It is preferred for patients who do not respond to conservative treatments, local anesthetic creams, or pharmacological agents, with the aim of optimizing sensory nerve transmission in the penis.
Preoperative Evaluation and Preparation
Before undergoing surgery, patients must undergo a detailed urological examination. During this process, glans sensitivity is measured objectively using methods such as biothesiometry. Preoperative preparations include:
- Detailed sexual history analysis and exclusion of psychogenic factors
- Control of systemic diseases and bleeding parameters
- Routine preoperative anesthesia preparations and obtaining informed consent
How is Selective Dorsal Nerve Modulation Surgery Performed?
The operation is a delicate procedure performed under microsurgical principles. It is usually conducted under general or spinal anesthesia and takes approximately 45 to 60 minutes. The main surgical steps are as follows:
1. Incision and Access
A small incision is made at the subcoronal line (circumcision line) or the base of the penis, and the skin is retracted. Buck's fascia is opened to expose the dorsal neurovascular bundle.
2. Isolation and Selection of Nerves
Using a microscope or surgical loupes, the dorsal nerve branches supplying the glans penis are isolated individually. The main trunk is preserved, and the side branches causing hypersensitivity are identified.
3. Modulation (Partial Resection)
A specific proportion of the identified nerve branches (typically around 50-70%) is selectively cut or modulated so that the penis does not completely lose normal erection and tactile sensation. Preserving motor nerves and major arteries is of critical importance during this stage.
4. Closure and Dressing
After meticulous control of bleeding (hemostasis), Buck's fascia and the skin tissue are closed with absorbable sutures. A light pressure dressing is applied to the penis.
Postoperative Recovery Process
Patients are usually discharged on the same day or the day after the operation. The recovery period is managed as follows:
- Mild swelling and bruising are considered normal during the first few days.
- Sutures are self-absorbing; there is no need for suture removal.
- Sexual intercourse must be avoided until complete healing is achieved (average of 4 to 6 weeks).
- Avoiding heavy physical activities for the first 2-3 weeks is recommended.
Risks and Potential Complications
As with any surgical procedure, selective dorsal nerve modulation carries certain risks. These include temporary numbness, infection, hematoma formation, and rarely, permanent loss of sensation. Proper patient selection and the use of microsurgical techniques minimize complication rates.