presentation of new operation - Alaa Aglan (8) - for treatment of premature ejaculation in patients with good response to Alcohol, or partial response to local anesthetics.

21 patients underwent surgery (2016/5/11 – 2016/12/5) at Alaa Clinic Hospital, Egypt. 
Criteria: hetro sexual, age (25-45), good response to alcohol, or partial response to local anesthetics, ejaculation time less than one minute.
Approach: modified Maylard in seventeen patients, laparoscope in four patients Fig1, Frenular delta: simple excision, peno-scrotal incision for neurectomy, dorsal selective in fourteen patients, ventral selective in three patients and both in four patients.

after six months follow up period, nineteen patients reported ejaculation time more than three minutes up to seven minutes, one patient reported two minutes, one patient reported one minute,Numbness was reported in four patients (improved within three months), neuroma was reported in one patient, and re-excision of proximal end of nerve was done under local anesthesia after two months with excellent improvement.

We cut the right hypogastric nerve immediately after of the trunk Fig2. The crossing of nerve fibers allows compensating unilateral cutting. We cut the right side, this inhibits emission phase, bilateral cutting cause’s retrograde ejaculation. We teach patient to inject local anesthetics around the nerve/s for neurectomy at root of penis then instruct him to practice sex or masturbate to make sure that neurectomies will not cause erectile dysfunction or other complications, also we dissect the nerve/s a long penis shaft then cutting them at penis root and pull the distal end towards glans to prevent reunion and allow re-suturing if needed.as the nerve diameter is obvious at root area. Theoretically, we can inject local anesthesia at right hypogastric branch and electrically stimulate the left branch if ejaculation occurs this means it is safe to cut right branch and vice - versa, also Theoretically, we can use electrical devices like vagal inhibition devices as an alternative to nerve cutting, the device may be used either unilaterally or bilaterally or even at the trunk itself but the cost is too much so we did not try to use it in this study. In one patient, we found the right side branch of hypogastric nerve well developed and larger than left branch so we didn’t cut it and we did dorsal and ventral neurectomies Fig3 around penis.

Alaa Aglan (8) operation is a promising option for treatment of premature ejaculation; more studies are needed to enable us to know its safety and efficacy.