Adult Section: Epididymitis, Penile Lengthening Surgery, and Dorsal Nerve Block

67. Why does the epididymis become inflamed?

The epididymis is hidden within the scrotum and attaches to the testicle. Why is it prone to inflammation? This is mainly determined by the anatomical structure of the epididymis. The epididymis is divided into three parts: head, body, and tail, with the tail forming the epididymal duct. The epididymal duct extends upwards to become the vas deferens, which further connects to the urethra via the prostate. Therefore, bacteria from the urethra, prostate, or seminal vesicles can invade the epididymis through this passage, causing inflammation, especially when the patient's resistance is lowered. Symptoms include sudden pain in the scrotum, swelling and significant tenderness of the epididymis, possibly accompanied by fever and epididymal induration. Inflammation of the epididymis can affect sperm maturation, reducing its fertilization capacity; inflammation can also cause blockage of the epididymal duct, affecting sperm output.

Treatment for epididymitis includes:

(1) General treatment includes bed rest, elevating the scrotum, and using a scrotal support or a large, self-made scrotal support with cotton padding. For those experiencing increased pain, analgesics can be used. Local heat therapy can relieve symptoms and promote inflammation resolution. However, premature use of heat therapy can worsen pain and carries the risk of promoting the spread of infection; therefore, early application of ice packs is recommended. Sexual activity and strenuous physical labor should be avoided.

(2) When using drugs, choose antibiotics that are sensitive to bacteria. Usually, after 1 to 2 weeks of intravenous administration, take oral antibiotics for 2 to 4 weeks. Be alert to the possibility that acute inflammation may become chronic if it persists.

(3) Surgical treatment: Epididymitis can generally be cured with effective antibiotic treatment. However, if antibiotic treatment is ineffective and testicular ischemia is suspected, epididymotomy should be performed, with multiple longitudinal or transverse incisions of the visceral tunica vaginalis of the epididymis.

**68. Is penile lengthening surgery a viable option?**

With societal progress, people's demands for the quality of their sex lives are increasing. Various types of penile surgeries are gradually gaining public attention, such as penile lengthening surgery. Penile lengthening surgery involves cutting the superficial and deep suspensory ligaments of the penis at appropriate locations based on the individual man's physiological characteristics and lengthening needs. This allows the portion of the corpus cavernosum buried within the body to be released, and an internal filling and external pulling suturing technique is used to lengthen the external portion of the penis by 3-5 centimeters.

Penile lengthening surgery has its advantages, but you must think carefully before deciding to have the procedure.

(1) Not everyone needs surgery. Adult men with underdeveloped penises, whose length is less than 10 cm when fully erect and cannot satisfy their female sexual needs; or those with most of their penis missing, whose length when erect is generally only 3 to 5 cm, may undergo penile lengthening surgery.

(2) Treatment must be sought at a reputable urology hospital or a large, qualified hospital. The hospital should have high-standard, specialized equipment to avoid or reduce the risk of nosocomial cross-infection before and after the procedure.

(3) Patients with inflammation of the foreskin or glans penis need to be treated in advance, and the surgery should be performed after the inflammation subsides.

Penile lengthening surgery is a minor procedure in modern medicine, but it's a major concern for men. Good results and proper post-operative recovery significantly impact a man's life and work. However, inadequate post-operative care can lead to ineffective surgery or even damage to important anatomical structures such as the corpora cavernosa, dorsal penile arteries and veins, deep penile veins, and dorsal penile nerves, potentially preventing the restoration of normal male sexual function. Therefore, choosing this surgical procedure requires careful consideration.

**69. Is penile dorsal nerve block surgery really a panacea?**

With the improvement of living standards and people's requirements for sexual life, penile dorsal nerve block surgery is gradually coming into people's view.

Dorsal penile nerve block surgery is mainly used for patients with primary premature ejaculation. The principle is to selectively block the dorsal penile nerve, reducing the excitability of the sensory nerves in the glans penis, increasing the penile sensory threshold, reducing the reflexes of the corpus cavernosum muscle, and decreasing the input of sexual stimulation, thereby prolonging the ejaculation latency period and indirectly improving ejaculatory control. Postoperative prophylactic antibiotics are used for 2-3 days, and sexual activity can generally be resumed one month after surgery.

Penile dorsal nerve block surgery is particularly effective for patients with primary premature ejaculation, especially those whose premature ejaculation is caused by long-term phimosis (tight foreskin) covering the glans penis, leading to hypersensitivity of the glans mucosa. However, surgery is an invasive procedure with risks, such as damage to surrounding tissues or the main nerve trunk, which could worsen sexual dysfunction. Furthermore, not all patients with premature ejaculation benefit from this surgery, especially those with secondary premature ejaculation due to conditions such as hypertension or diabetes.

Penile dorsal nerve block surgery offers a novel treatment option for patients with premature ejaculation. However, this procedure is relatively new and not yet widely available; skilled surgeons are extremely rare. Therefore, careful consideration is essential when choosing a surgeon.