Alaa Aglan (9) is a new operation, it consists of right hypogastric nerve excision(Fig1) (inhibits emission phase), bulbospongiosus muscles cutting – bilaterally - , frenular delta excision (both inhibit expulsion phase), and selective dorsal neurectomy (inhibits expulsion phase and decrease signaling to the brain).

: 23 patients underwent surgery (2016/10/3 – 2017/3/17) at Alaa clinic hospital, Egypt. Criteria: hetro-sexual, age (23 – 44), ejaculation time less than 30 seconds no or inadequate response to medical treatment or previous unsatisfactory surgeries. Approach: right hypogastric nerve excision: modified Maylard in twenty patients and laparoscope in three patients (Fig2). Muscle cutting and neurectomy: peno-scrotal incision. Frenular delta: simple excision.

After six months follow up period: one patient reported ejaculation time sixteen minutes, one patient reported thirteen minutes, one patient reported eleven minutes,two patients reported seven minutes,twelve patients reported ( 4 - 5 ) minutes,four patients reported two minutes, one patient reported one minute. Neuroma reported in one patient treated medically, four patients were not satisfied.frenular delta excision is safe as it is excised in many over circumcised persons without complications, muscle cutting ( bulbospongiosus ) is safe as we saw clinically in many of cases this underwent various types of Alaa Aglan operations, the muscle may be congenitally absent in normal persons or in cases of hypospedius or epispedius without effect. In neurectomy (around penis) we dissect the nerve a long penis shaft then we cut it at the penis root and pull the distal end away towards glans to prevent reunion and allow re-suturing if needed as the nerves diameter are obvious at root area.

Alaa Aglan (9) operation is recommended for cases not responding to medical treatment, more studies are needed to explore its efficacy and safety.