ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 12 of 41
УЖМБС 2017, 2(3): 65–70
Clinical Medicine

Results of Gel Implantation of Hyaluronic Acid under Mucous Balanus for Treatment of Early Ejaculation

Knihavko O. V.

Early (rapid) ejaculation is widespread problem which decreases sexual satisfaction and self-estimation of men and it can be the main factor of sexual disharmony of the couple. Patients require minimally invasive methods of treatment due to not enough efficacy of sexological methods and medial efficacy of neurological medicines. It has been explained and analyzed results of the use of gel injections of hyaluronic acid in the balanus for the treatment of early ejaculation (EE). Materials and methods: 849 patients with early ejaculation were involved in the research in 2007-2017. Results of diagnostics and treatment of 49 patients with early ejaculation and intravaginal latent interval less than 1 minute were investigated. The group of patients with penile hypersensitivity and the absence of psycho-neurological problems was created due to the use of penile biothesiometry, collection of sexual anamnesis and also the use of Hamilton scale. 2 ml of gel of hyaluronic acid was administered to these patients under mucous balanus and frenum of penis and it was dissolved during 9-12 months. In such intervals as from 1 to 18 months investigation of procedure efficacy was done and it was investigated by intravaginal latent interval, satisfaction during sexual intercourse (coition), result’s maintenance. Results: Analyzing received information it can be indicated that duration of sexual intercourse increases significantly in comparison with the initial index from 1 to 6 months after gel implantation of hyaluronic acid. However, from 9 to 15 months intravaginal latent interval decreases every month that is caused by filler biodegradation. From 15 month to the end of examination (in 1,5 year after surgery) there is stabilization of coition that can be explained as terminal results of early ejaculation as full biodegradation of gel substance. 25 (100%) percent of examined patients who estimated results of treatment negatively, the presence of disease recurrence was indicated as the main cause of patients’ negative response. Local therapy by topical anesthetic agents, recurrent implantation of gel of hyaluronic acid under mucous glandular part of penis or selective penile denervation was proposed to such patients. 13 (52%), 6 (24%) and 2 (8%) patients accepted these types of treatment. 4 (16%) patients did not accept any type of treatment. From 19 patients who did not get recurrent glandular implantation of filler, in 14 (73,7%) of investigations high price of operation was the main reason of negative response. It was caused by the price of gel of hyaluronic acid (the price of 1 ml of Juviderm is about Euro, for this method 2 ml of gel should be administered). In main group of patients the increase of intravaginal latent interval was detected in 6 times to 5 minutes, which reduces gradually and in 18 months it was 138,7+71,5 sec. Satisfaction by coition to 9 months was 91,2%, and then it decreased to 49% in 18 months. Conclusions: The use of injections of gel of hyaluronic acid is relatively effective during 9-12 months and efficacy reaches 49%. Considering the high price of European original gel, this method has small number of respondents and it is recommended only for patients with middle severity of early ejaculation or as the first attempt of minimally invasive methods in patients who are afraid of microsurgical denervation of balanus.

Keywords: early ejaculation, injections of gel of hyaluronic acid

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  1. Abdallah H, Abdelnasser T, Hosny H, Selim O, Al-Ahwany A, Shamloul R. Treatment of premature ejaculation by glans penis augmentation using hyaluronic acid gel: a pilot study. Andrologia. 2012; 44 Suppl 1: 650-3.
  2. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, et al. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). J Sex Med 2014; 11: 1392-422.
  3. Atan A, Basar M, Tuncel A, Ferhat M, Agras K, Tekdogan U. Comparison of efficacy of sildenafil -only, sildenafil plus topical EMLA crem, and topical EMLA-crem-only in treatment of premature ejaculation. Urology. 2006; 67: 388-91.
  4. Chen J, Kern-Paz G, Bar-Yoser Y, Matzkin H. The role of phosphodiesterase type 5 inhibitors in the management of premature ejaculation: a critical analysis of basic science and clinical data Eur Urol. 2007; 52: 1331–9.
  5. Donatucci C. Etiology of ejaculation and pathophysiology of premature ejaculation. J Sex Med. 2006; 3 (4): 303–8.
  6. Kim JJ, Kwak TI, Jeon BG, Cheon J, Moon DG. Human glans penis augmentation using injectable hyaluronic acid gel. Int J Impot Res. 2003; 15 (6): 439-43.
  7. Kwak TI, Jin MH, Kim JJ, Moon DG. Long-term effects of glans penis augmentation using injectable hyaluronic acid gel for premature ejaculation. Int J Impot Res. 2008; 20 (4): 425-8.
  8. Lee J. Potential Risks for the Off-Label Use of SSRIs in Premature Ejaculation (CME). J Sex Med. 2010; 7 (8): 2622–4.
  9. Masters W, Johnson V. Premature ejaculation. Masters WH, Johnson VE eds, Human Sexual Inadequacy. Boston MA: Little, Brown and Co, 1970.
  10. McMahon C, Althof S, Waldinger M, Althof SE, Shindel A, Adaikan G, Becher EF, Dean J, et al. An evidence-based definition of lifelong premature ejaculation: report of the International Society for Sexual Medicine (ISSM) ad hoc committee for the definition of premature ejaculation. J Sex Med. 2008; 5 (7): 1590–606.
  11. Montorsi F, Adaikan G, Becher E, Giuliano F, Khoury S, Lue TF, Sharlip I, Althof SE, Andersson KE, Brock G, Broderick G, et al. Summary of the recommendations on sexual dysfunctions in men. J Sex Med. 2010; 7 (11): 3572–88.
  12. Moon du G, Kwak TI, Kim JJ. Glans Penis Augmentation Using Hyaluronic Acid Gel as an Injectable Filler. World J Mens Health. 2015; 33 (2): 50-61.
  13. Rowland D. Penile sensitivity in men: a composite of recent findings. Urology. 1998; 52 (6): 1101–5.
  14. Salonia A, Maga T, Colombo R, Scattoni V, Briganti A, Cestari A, Guazzoni G, Rigatti P, Montorsi F. A prospective study comparing paroxetine alone versus paroxetine plus sildenafil in patients with premature ejaculation. J Urol. 2002; 168 (6): 2486–9.
  15. Schuster T, Ohl D. Diagnosis and treatment of ejaculatory dysfunction. Urol Clin North America. 2002; 29 (4): 939–48.
  16. Symonds T, Roblin D, Hart K, Althof S. How does premature ejaculation impact a man s life? J Sex Marital Ther. 2003; 29: 361-70.
  17. Waldinger M. Towards evidenced based drug treatment research on premature ejaculation: a critical evaluation of methodology. J Impot Res. 2003; 15 (5): 309–13.
  18. Wespes E, Amar E, Eardley I, et al. Guidelines on Male Sexual Dysfunction: Erectile dysfunction and premature ejaculation. EAU Guidelines. 2011; p 4–47.
  19. Zhang H, Zhang C, Li X, Fu ZZ, Chen ZY. Dorsal penile nerves and primary premature ejaculation. Chinese Medical Journal. 2009; 122 (24): 3017–9.
  20. Lesovoy VN, Knigavko AV, Arkatov AV, Savenkov VI, Kartavtsev AV. Maloinvazivnye metody lecheniya eyakulyatornykh rasstroystv. Zdorove muzhchiny. 2015; 2: 87-91.