Clinical efficacy and safety of selective dorsal neurectomy/cryoablation for treatment of premature ejaculation: systematic review and meta-analysis

Abstract Introduction Premature ejaculation (PE) is a prevalent sexual dysfunction with limited treatment options for some patients. Selective dorsal neurectomy/cryoablation (SDN/CA) has emerged as a potential treatment, aiming to desensitize the penis. Objectives To assess the efficacy of SDN/CA on intravaginal ejaculation latency time (IELT), PE-related questionnaires, treatment satisfaction, erectile function, and adverse events in the treatment of PE. Method A systematic review and meta-analysis were conducted, including randomized controlled trials, clinical trials, and prospective/retrospective studies. Databases such as Embase, PubMed, Cochrane, and Web of Science were searched. The Cochrane risk-of-bias tool and Risk of Bias in Non-randomized Studies of Interventions-I tool were used for quality assessment. IELT (sec), questionnaires (Premature Ejaculation Diagnostic Tool, Premature Ejaculation Profile, Sexual Satisfaction Score), erectile status (IIEF [International Index of Erectile Function]-5), and adverse events were evaluated. Comprehensive meta-analysis and R software were used for statistical analyses. Results Seven studies (235 patients) were included. SDN/CA significantly improved IELT (mean difference: 147.47 sec, P < .05). Questionnaires showed improvements in sexual satisfaction and ejaculation control. No meaningful change was observed in the erectile function. The adverse event rate was 11.17%, with no significant difference between groups. Conclusion SDN/CA is controversial as a treatment option for PE, affecting IELT and patient satisfaction. The heterogeneity of the included studies and short-term follow-up periods shed light on further research. However, further research into standard protocols and longer follow-ups is needed.