the hypogastric nerve fibers shows crossing at bifurcation level and pelvic ganglia level, so cutting of the nerve at right side could be compensated. If we cut the nerves, bilaterally retrograde ejaculation occurs.

20 patients underwent surgery (2016/2/27 – 2016 /8/23) at Alaa Clinic hospital, Egypt. Criteria: Age (21 – 47), hetro sexual, No response to local anesthetics or good response to alcohol, ejaculation time less than 30 seconds. Approach: modified Maylard incision We cut the right hypogastric nerve directly after bifurcation of hypogastric trunk, then we dissect the distal end and pull it towards pelvis to prevent reunion and allow re-suturing if needed (we didn’t cut a segment from the nerve).

After six months follow up period: one patient reported improvement of ejaculation time till 15 minutes, two patients reported 8 minutes, fifteen patients reported (3 – 4) minutes, one patient reported one minute ( previously ejaculation was immediately before entrance ), two patients reported wound seroma ( early removal of the drain ), one patient reported internal bleeding. . Exploration was done we found bleeding from rectus muscles. We sutured the muscle carefully and no blood transfusion was needed, Most of patients reported wet dreams in first week; Wet dreams are most likely due to nerve manipulation. Retrograde ejaculation was not reported. Theoretically, we can do a test before excision of the right hypogastric nerve. We can inject local anesthetics at right hypogastric nerve after bifurcation area directly and stimulate the left branch electrically, if ejaculation occurs this means it is safe to excise the nerve and vice versa ( but actually we didn’t apply this test in this study ). Also theoretically, we can use electrical devices like vagal inhibition devices unilaterally or bilaterally or even at the trunk itself but the cost is too much so we did not try to use it in this study.

Alaa Aglan (6) operation is a promising treatment for premature ejaculation; more studies are needed to clarify its safety and efficacy.