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

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.