Selection of method of treatment in secondary premature ejaculation

Abstract

Premature ejaculation (PE) – a persistent attack of orgasm and ejaculation in a man before the onset of orgasm in a woman – a fairly common disease, which according to different authors suffers from 25% to 40% of men, mostly young. Despite such a wide spread of premature ejaculation, there are still no clear guidelines for its treatment in Ukraine, especially the secondary (acquired) form, which manifested itself sometime after a successful sexual life.

The objective: to determine the most common causes of secondary premature ejaculation (SPE) and the effectiveness of various methods of its treatment.

Materials and methods. In 2007–2017 in the andrological department of the KZOZ «RCCUN them. V.I. Shapoval», 906 patients with premature ejaculation were examined. In this sample, the results of diagnosis and treatment of 379 patients with secondary PE with an Intravaginal ejaculation latency time (IELT) were evaluated for less than 2 minutes. Based on penile biothesiometry, sexual history, study of urological complaints, doppler ultrasound examination of the prostate and scrotum, analyzes for sexually transmitted infections, and the use of the scale of autonomic dysfunction and the Hamilton scale (HRDS), there are suggestions for the most likely cause of PE. This allowed the patients to be divided into 4 groups. Group 1 – 124 patients with normal penile sensitivity without deviations in the psychoneurological status with diagnosed chronic prostatitis (CP), who underwent antibacterial treatment according to the sensitivity of the isolated infectious agents; Group 2 consisted of 84 patients with CP and the presence of varicocele, which, in addition to antibiotic therapy, were underwent Marmara surgery; Group 3 – 77 patients with CP, who along with antibacterial therapy were additionally assigned prostatoprotector (Vitaprost); Group 4 – 94 patients with neurological complaints and high anxiety HRDS >14, whose treatment consisted in the appointment of a selective serotonin reuptake inhibitor (SSRI) sertraline by a course of 6 months at a dose of 50 mg per day.

Results. After 1 and 7 months, the effectiveness of the treatment was determined by the lengthening of the intravaginal ejaculatory latent time (IELT), the satisfaction of sexual intercourse on the Rosen scale, the number of patients satisfied with the results of treatment and the absence of the need to take the drugs in the future. In group 1, the duration of IELT increased by 1,85 times, eradication of the disease reached 78,3%, high results were observed in the absence of complaints in 91,2% of patients, but in respect of the SPE, the efficacy was not high – only 56,2%. In the 2nd group, high eradication cure was noted – 87,3%, almost complete absence of complaints and high efficiency with respect to the SPE – 79,7%, increase in IELT – by 2,54 times. In the third group, eradication cure reached 89,4%, almost no complaints and high efficiency with respect to the SPE – 83,1%, increased by 2,72 times. In the fourth group of patients receiving sertraline, the average increase in IELT was 2,36 times, the efficacy with respect to SPE was 64,5%.

Conclusions. 1. The cause of SPE is most often chronic prostatitis and prostatevisculitis (78%).

2. The appointment of SSRI in case of SPE is rational only in the presence of neurological symptoms (HRDS >14) and absence of CP.

3. Varicocele (especially bilateral) is a comorbid factor of CP, causing venous hyperemia of the prostate, and may be one of the causes of SPE.

4. Operation Marmar reduces venous hyperemia of the prostate, reduces the score of IPSS, improves IELT in patients with comorbid pathology (varicocele + CP).

5. Antibacterial therapy of CP allows to cure SPE in 56%, the addition of prostatotropic drugs (Vitaprost) improves the effectiveness of treatment of SPE to 83%.