In our published study (Alaa Aglan operation). we reported a case of penile skin loss at anterior third of ventral aspect of penis and we cut the bulbospongiosus muscles and skin graft (split thickness) was applied at that area (frenular delta was lost due to skin loss) this patient reported improvement in ejaculation time from 2 minutes to 20 minutes, another patient came to us with penile abscess due to neglected wound after penile filler injection, the skin was lost at anterior third of ventral aspect of the penis. Skin graft (split thickness) was applied to cover the wound. That patient reported that the time of ejaculation improved from 2 minutes to 25 minutes although we didn`t cut the bulbospongiosus muscles. We thought about alternative way to grafting. The branches that supply that area are dorso-lateral branches of dorsal nerves plus terminal branches of preineal nerves. We excised nerve supply to that area plus frenular delta excision (elliptical part) both of previous techniques will together simulate the effect of skin grafting at that area. We applied spraying anesthesia (procomail®) at anterior third of ventral aspect of penis. The test is done 30 minutes before intercourse with precautions, No sexual activity at last 24 hours , No medications that  interferes  with sexual condition at same period also patient shouldn`t be congested or deprived from sex for long period before doing the test . This test allows us to predict the gained time accurately.
Objective: Magnification of the effect of Alaa Aglan operation by the synergistic effect of its combination with ventral neurectomy of penis

The study was done between 15/10/2011 and 17/2/2016, 218 patients were involved, follow up was done at 1, 3,6,12 months then yearly. Bulbospongiosus muscles were cut bilaterally, elliptical part of frenular delta was excised, and ventral neurectomy was done including perineal nerve terminals and dorsi-lateral branches of dorsal nerves at ventral anterior third of penis.

Satisfaction rate was 98%. All patients responded significantly to the operation. In our early trials beyond this study the satisfaction rate was 67% but we were not do prediction test at that time. The prediction test clinically means patient selection and it is the cause of the high satisfaction rate. The side effect were minimal infection, wound dehesience and oedema were treated medically. 4 patients reported numbness which disappeared within 3 months, 2 patients reported neuroma responded to single Botox injection (40 units).in our old trials ( beyond this study ) trimming of proximal end of the nerve was enough as a treatment ( one case only ).

Alaa Aglan(2) is a modification to Alaa Aglan operation, it is more potent, effective and is indicated if the prediction test was promising.