Pelvic muscle floor rehabilitation as a therapeutic option in lifelong premature ejaculation： long-term outcomes

The aim of the study was to evaluate the long-term outcomes of pelvic floor muscle （PFM） rehabilitation in males with lifelong premature ejaculation （PE）, using intravaginal ejaculatory latency time （IELT） and the self-report Premature Ejaculation Diagnostic Tool （PEDT） as primary outcomes. A total of 154 participants were retrospectively reviewed in this study, with 122 completing the training protocol. At baseline, all participants had an IELT 〈60 s and PEDT score 〉11. Participants completed a 12-week program of PFM rehabilitation, including physio-kinesiotherapy treatment, electrostimulation, and biofeedback, with three sessions per week, with 20 min for each component completed at each session. The effectiveness of intervention was evaluated by comparing the change in the geometric mean of IELT and PEDT values, from baseline, at 3, 6, and 12 months during the intervention, and at 24 and 36 months postintervention, using a paired sample 2-tailed t-test, including the associated 95% confidence intervals. Of the 122 participants who completed PFM rehabilitation, 111 gained control of their ejaculation reflex, with a mean IELT of 161.6 s and PEDT score of 2.3 at the 12-week endpoint of the intervention, representing an increase from baseline of 40.4 s and 17.0 scores, respectively, for IELT and PEDT （P 〈 0.0001）. Of the 95 participants who completed the 36-month follow-up, 64% and 56% maintained satisfactory eiaculation control at 24 and 36 months oostintervention, respectively.

The Role of Acupuncture Treatment in Obstructed Defecation Syndrome

Background:Obstructed defecation syndrome(ODS)is a group of symptoms that are mainly caused by pelvic floor dysfunction concerning bowel symptoms.It is challenging in clinical practice.Acupuncture has advantages in the treatment of complex symptoms because of its multi-target and bi-directional regulation of the human body.Since 2500 years ago,acupuncture has been applied empirically to the treatment of constipation.Does acupuncture have any effect on ODS?Objectives:By showing the clinical thoughts,methods,and achievements of acupuncture series in ODS in recent ten years by the author’s team,and two scientific papers published in English on acupuncture treatment of chronic intractable constipation and stress urinary incontinence,it is proved that the core scheme of acupuncture treatment of defecation disorder syndrome(ODS)is flexible.In order to raise awareness of the therapeutic effect of acupuncture in ODS,it can be integrated into existing practice to get opportunities for multidisciplinary cooperation and further research and development.Materials and Methods:By summarizing the diagnosis and treatment of ODS,the first-line selection of pelvic floor rehabilitation and the minimally invasive sacral neuromodulation were reviewed,and it was pointed out that there was a gap between the high demand of patients and the expectation of cost-effectiveness.Then,on the basis of modern eastern and western medical achievements,the holistic concept was introduced into the treatment of pelvic floor dysfunction,and an acupuncture scheme suitable for ODS was proposed.Results:Acupuncture is based on the idea of improving the patients’central nervous system,autonomic nervous system and intestinal nervous system,and is effective in treating ODS.The acupoints were set two groups when patient in supine position,which includes ST 25(Tianshu),SP 15(Daheng),SP 14(Fujie),CV 6(Qihai),CV 4(Guanyuan),ST 36(Zusanli),ST 37(Shangjuxu);When patient is in prone position,it includes BL 20(Pishu),BL 23(Shenshu),BL 25(Dachangshu),BL 33(Zhongliao),BL 34(Xialiao),and GV 20(Baihui).The key was the technique of deep needling of the ST 25(Tianshu)and deep needling of the BL 33(Zhongliao)&BL 34(Xialiao).It needs 2-15 Hz sparse-dense wave electrical stimulation,30 minutes each time,a total of 20 times,which was a scheme that could achieve satisfactory short-term and long-term effects.Conclusion:At present,clinical and basic experimental studies have proved that acupuncture plays a role in treating ODS in a multi-target way.This is a very promising research direction of pelvic floor integrated medicine.In the future,further study on optimizing the protocol and meeting the patient’s gap individually and cost-effectively.