LAUSR

First of all, I would like to congragulate the authors for their comperhensive review and meta-analysis on PE pharmacotherapy. Premature ejaculation (PE), which is a very common male sexual dysfunction, significantly decreases the quality of life for the patient and his sexual partner’s as it may cause psychological distress, diminished self esteem, anxiety, erectile dysfunction, reduced libido, and poor interpersonal relationships [1]. PE is found in 20–40% of the male population [2]. In this paper entitled “Pharmacotherapy of premature ejaculation: a systematic review and network meta-analysis (https ://doi.org/10.1007/s1125 5-018-1984-9)”, authors evaluated the effectiveness of PE pharmacotherapy according to the intravaginal ejaculatory latency time (IELT). Waldinger et al. firstly introduced the concept of the intravaginal ejaculatory latency time (IELT) in 1994 [3, 4]. IELT is the time from vaginal penetration to ejaculation. IELT may be either self-estimated by the male or measured directly with the use of a stopwatch. Although IELT is a useful measurement tool which is used in most of the PE studies, it may not always be practical for all of the patients. For this reason, International Society for Sexual Medicine’s Guidelines did not recommend use of IELT measurement for the diagnosis and treatment of PE in routine clinical practice [5]. Therefore, patients and partner based questionnaires which are called “Patient Reported Outcome (PRO)” measurement should be considered in the evaluation of PE pharmacotherapy [6]. The aim of the PE treatment should not only be improved latency time, but also a significantly improved sexual satisfaction for both men and their partners. In the diagnosis and treatment of PE, sexual satisfaction should also be considered. The PE patients and their partners may be satisfied by the treatment even with minimal improvement of the IELT. According to European Association of Urology guideline, combination of IELT and a single-item patient reported outcome (PRO) on control over ejaculation and satisfaction with sexual intercourse(scale ranging from 0 = very poor to 4 = very good) and on personal distress and inter-personal difficulty (0 = not at all, to 4 = extremely) is more useful for PE management [7]. In our previous studies, the patients’ clinical responses were assessed using the patient self-description method. The results were classified as unsuccessful, improvement, and cure [8–10]. This method is vey simple and easy. In addition to the patients’ evaluation by this simple method, their partners should also be involved in the evaluation process.