Glymphatic system activity revealed by diffusion tensor image analysis along the perivascular space analysis in lifelong premature ejaculation: a pilot study

BACKGROUND: Lifelong premature ejaculation (PE) is a commonly reported male sexual dysfunction. However, investigations focusing on the glymphatic system of lifelong PE are still limited. AIM: To investigate alterations of glymphatic function and potential correlation between the diffusion tensor image analysis along the perivascular space (DTI-ALPS) index and clinical symptoms of lifelong PE patients. METHODS: Our study enrolled 36 lifelong PE patients and 30 matched healthy controls (HCs). DTI-ALPS index was calculated through diffusion tensor imaging sequence. Statistical analysis was performed, including intergroup comparisons, correlation assessments, and subgroup analyses. OUTCOMES: The results comprised 2 sample t-tests comparing intergroup DTI-ALPS values and their correlations with clinical scales, in addition to 2 sample t-test results comparing lifelong PE patients with high depressive states and those with low depressive states. RESULTS: The results demonstrated that lifelong PE patients exhibited a significantly lower DTI-ALPS index compared to HCs. The decreased DTI-ALPS index was negatively correlated with the severity of lifelong PE. Furthermore, lifelong PE patients with high depressive states had significantly lower DTI-ALPS index than those with low depressive states. CLINICAL IMPLICATIONS: This study offers a potential neurobiological explanation for the condition, which could inspire the development of new diagnostic tools or therapies targeting the glymphatic system. STRENGTHS AND LIMITATIONS: The major strength of this research is the innovative use of the DTI-ALPS index to objectively evaluate glymphatic function in lifelong PE, providing novel insights into its neuropathophysiology. However, the study is limited by its small sample size. To ensure robust generalizability, future work will involve the acquisition of larger-scale cohorts. CONCLUSION: These findings provide further evidence for the existence of intracranial waste clearance efficiency abnormalities in lifelong PE patients and suggest that the decreased glymphatic system activity in patients may be implicated in emotional state and the disease severity. These findings may offer new perspectives for understanding the pathophysiology of lifelong PE.