Hyaluronic Acid vs Botulinum Toxin Injection in Treatment of Lifelong Drug-Resistant Premature Ejaculation: Randomized Study

Inclusion Criteria: * Adult male patients aged 22 to 45 years. * Sexually active and in a stable heterosexual relationship. * Circumcised. * Able to understand and comply with study procedures and follow-up visits. * Diagnosed with lifelong drug-resistant premature ejaculation, defined as persistent ejaculation within one minute of penetration despite prior pharmacologic or behavioral therapy. * Normal serum total testosterone, prolactin, and thyroid-stimulating hormone levels. * Willing to provide written informed consent. Exclusion Criteria: * Presence or history of erectile dysfunction or other sexual or ejaculatory disorders such as retrograde ejaculation or acquired premature ejaculation. * History of acute or chronic prostatitis. * Any debilitating medical condition including hepatic failure, renal failure, or uncontrolled diabetes mellitus. * Previous pelvic or spinal surgery. * Prior chemotherapy or radiotherapy. * Use of antipsychotic or neuroactive medications that may affect ejaculation. * History of substance abuse or current drug dependence. * Presence of penile prosthesis, penile deformity, or anatomic abnormalities of the glans or shaft. * Known hypersensitivity or allergy to botulinum toxin or hyaluronic acid preparations. * Any condition that, in the investigator's opinion, may interfere with the safety or evaluation of the study treatment.