Clinical effect of computed guided pudendal nerve block for patients with premature ejaculation: a pilot study

Abstract

Background: Premature ejaculation has a complex etiology, and its pathophysiology is still unclear, with penile hypersensitivity being the most accepted hypothesis. The aim was to investigate the efficacy and safety of a computed tomography-guided pudendal nerve block at the level of the sacrospinous ligament and the Alcock’s canal in patients with premature ejaculation refractory to conventional pharmacological treatment.

Methods: This is a prospective pilot study involving five patients suffering from premature ejaculation refractory to standard treatment and clinical features of pudendal nerve entrapment. A CT-guided infiltration of ropivacaine and methylprednisone was done at the levels of sacrospinous ligament and Alcock’s canal. Intra-vaginal ejaculatory latency time (IELT) was recorded several times for each patient before and after infiltration. International Index of Erectile Function (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT) and Sexual Quality of Life–Male version (SQoL-M) questionnaire were also evaluated before and after infiltration.

Results: Overall IELT differed significantly before and after treatment (21.94 vs 215.42 s; p = 0.039). IIEF-5, PEDT and SQoL-M also differed significantly before and after treatment. No complications for the CT-guided infiltration were recorded.

Conclusion: CT-guided pudendal nerve block at the sacrospinous ligament and the Alcock’s canal was effective in improving premature ejaculation. Therefore, pudendal nerve entrapment may be a curable cause of sensory premature ejaculation.

Keywords:

• Premature ejaculation
• pudendal nerve
• pudendal nerve entrapment
• CT-guided

Author contributions

Conceptualization: F. Aoun, F. Absil and R. Bollens. Methodology: F. Aoun, F. Absil and R. Bollens. Formal analysis: F. Aoun, G. Mjaess and J. Assaf. Investigation: F. Aoun, A. K. Chemaly, T. Younane, and R. Bollens. Writing – Original draft: F. Aoun and G. Mjaess. Writing – Review and editing: F. Aoun, G. Mjaess, J. Assaf, A. K. Chemaly, S. Albisinni and T. Roumeguère.

Disclosure statement

No potential conflict of interest was reported by the author(s).