Clinical outcomes of selective dorsal cryoneurolysis in patients with lifelong premature ejaculation: a retrospective cohort of 108 men.

BACKGROUND: Selective dorsal cryoneurolysis (SDC) is a minimally invasive, potentially reversible neuromodulatory intervention for men with lifelong premature ejaculation (PE) refractory to conventional therapy. AIM: To evaluate the efficacy, safety, and objective sensory effects of SDC in men with lifelongPE. METHODS: This retrospective cohort included 108 men with lifelong PE (mean age 40.4 ± 11.6 years; body mass index 25.5 ± 3.2 kg/m2) who underwent SDC between January 2024 and January 2025. All reported stopwatch-measured intravaginal ejaculatory latency time (IELT) <1 min, normal erectile function, and inadequate response to pharmacological and behavioral treatment. Intravaginal ejaculatory latency time, Premature Ejaculation Diagnostic Tool (PEDT), Premature Ejaculation Profile (PEP), penile vibration-perception thresholds (biothesiometry), adverse events, and treatment failure were assessed to 12 months. Complete data were available for all patients, with no loss to follow-up. Normality was tested with Shapiro-Wilk; changes over time were analyzed with Wilcoxon signed-rank and paired t-tests and the Friedmantest. OUTCOMES: The primary outcome was change in IELT; secondary outcomes were PEDT and PEP scores and adverse events. RESULTS: Geometric-mean IELT rose from 54.4 s (95% confidence interval [CI], 45.8-64.5) to 231.3 s at 12 months (95% CI, 209.1-256.0)-an approximately 4-fold improvement first reached by month 3 and sustained thereafter (P < .001). Premature Ejaculation Diagnostic Tool decreased from 14.3 ± 2.3 to 8.4 ± 2.1 and the total PEP score increased from 6.0 ± 2.0 to 11.6 ± 2.4 (both P < .001). Penile thresholds rose from ~4.5 to ~10.7 V at all sites (P < .001), confirming objective desensitization. Procedure-related discomfort occurred in 8/108 patients (7.4%), all mild and self-limiting, and persistent PE in 11/108 (10.2%); 82/108 (75.9%) underwent a second and 22/108 (20.4%) a third session. No erectile dysfunction, anorgasmia, persistent numbness, or infection occurred. CLINICAL IMPLICATIONS: Selective dorsal cryoneurolysis provides significant, sustained improvements in ejaculatory latency and patient-reported outcomes without compromising sexual function, although approximately one in ten patients did not achieve a meaningful response. STRENGTHS AND LIMITATIONS: Strengths include a relatively large cohort, standardized outcome measures, and objective sensory (biothesiometry) testing. Limitations include the retrospective, uncontrolled, non-randomized design, and the absence of partner-reported outcomes. CONCLUSION: Selective dorsal cryoneurolysis appears to be a safe, effective, minimally invasive, and potentially reversible option for refractory lifelong PE, positioned between pharmacotherapy and permanent neurotomy. It remains investigational, and prospective randomized controlled trials are warranted to confirm long-term durability and comparative efficacy.