Management and treatment variations in premature ejaculation: a nationwide survey by the Andrology Working Group of the Society of Urological Surgery in Turkey

Purpose: This study aimed to evaluate the diagnostic and therapeutic approaches to premature ejaculation (PE), focusing on variations in clinical practices and guideline adherence. Methods: A structured survey was anonymously distributed via Google Forms to 900 clinicians between April 30 and June 10, 2024, of whom 378 completed the questionnaire, yielding a response rate of 42%. Participants included urologists, andrologists, psychiatrists, and sexual psychotherapists. The questionnaire covered diagnostic criteria, laboratory investigations, treatment preferences, management strategies for comorbid conditions, along with attitudes toward behavioral and invasive interventions. Statistical analyses included descriptive statistics, chi-square, and Fisher’s exact tests. Results: The study revealed marked variability in the diagnosis and treatment of PE. While the ISSM definition was the most commonly used guideline (40.5%), psychiatrists predominantly relied on DSM-5-TR criteria (88.2%). Laboratory testing, including testosterone and thyroid function evaluations, was employed by 54.2% of participants. Dapoxetine was the most preferred first-line therapy (31.2%), followed by behavioral therapies (20.6%) and local anesthetics (19.6%). For patients unresponsive to initial therapies, couple-based sexual psychotherapy (18.6%) and use of long-acting daily SSRIs (14.8%) were the most preferred second-line treatments. Combination therapies were widely adopted (89.1%), though their components varied significantly. Surgical and invasive treatments, such as hyaluronic acid injections, were rarely utilized (18.3%), with most physicians reserving them for refractory cases. Pelvic floor relaxation exercises were recommended by 72% of participants, while 87.5% endorsed behavioral therapies for PE. Conclusion: This study revealed substantial variability in PE management, its multifaceted etiology and guideline limitations. The findings underscore the need for standardized, evidence-based protocols to enhance clinical outcomes and optimize patient satisfaction.