Premature Ejaculation Surgery is surgical procedure to correct premature ejaculation(PE) disorder.
Premature ejaculation (PE) is a common male sexual disorder. Premature ejaculation (PE) is one of the most common male sexual disorders and has been estimated to occur in 4-39% of men in the general community.
Ejaculation is a reflex comprised of sensory receptors and areas, afferent pathways, cerebral sensory areas, cerebral motor centres, spinal motor centres and efferent pathways. There are three basic mechanisms involved in normal antegrade ejaculation-emission, ejection and orgasm. Emission is the result of a sympathetic spinal cord reflex initiated by genital and / or cerebral erotic stimuli and involves the sequential contraction of accessory sexual organs. Considerable initial voluntary control of emission progressively decreases until the point of ejaculatory inevitability. Ejection also involves a sympathetic spinal cord reflex upon which there is little or no voluntary control. Ejection involves bladder neck closure, rhythmic contractions of bulbocavernous, bulbospongiosus and other pelvic floor muscles and relaxation of the external urinary sphincter.Orgasm is the result of cerebral processing of pudendal nerve sensory stimuli resulting from increased pressure in the posterior urethra, sensory stimuli arising from the veramontanum and contraction of the urethral bulb and accessory sexual organs.
The ejaculatory reflex is predominantly controlled by a complex interplay between central serotonergic and dopaminergic neurons with secondary involvement of cholinergic, adrenergic, nitrergic, oxytocinergic, galanergic and GABAergic neurons. The cerebral events which occur during ejaculation and the abnormalities present in men with PE have not been clearly defined with positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) techniques. Seminal emission and ejection are integrated into the complex pattern of copulatory behavior by several forebrain structures including the medial preoptic area (MPOA) and the nucleus paragigantocellularis (nPGi) Descending serotonergic pathways from the nPGI to the lumbosacral motor nuclei tonically inhibit ejaculation. Disinhibition of the nPGI by the MPOA facilitates ejaculation. A population of lumbar spinothalamic neurons has been identified in male rats (LSt cells) that constitute an integral part of the generation of ejaculation. LSt cells send projections to the autonomic nuclei and motoneurons involved in the emission and expulsion phase and receive sensory projections from the pelvis.Several brain areas are activated after ejaculation by ascending fibres from the spinal cord and may have a possible role in satiety and the postejaculatory refractory time.