Management of premature ejaculation (PE) has evolved tremendously over the past two decades. Pharmacotherapy, particularly selective serotonin reuptake inhibitors (SSRIs) and topical anesthetics, is the cornerstone of current guidelines. However, the limitations of these therapies, including recurrence after withdrawal and variable efficacy, have prompted interest in alternative approaches. Before the establishment of the International Society for Sexual Medicine (ISSM) guidelines, surgical techniques such as selective dorsal neurectomy (SDN) and glans penis augmentation (GPA) using hyaluronic acid (HA) gel were developed to address penile hypersensitivity in PE. Although not currently recommended in Western guidelines due to concerns about sensory loss and insufficient data, these procedures have continued to gain popularity in Asian countries. This chapter reviews the history, technical aspects, reported efficacy, and controversies surrounding surgical treatments for PE, emphasizing the need for reevaluation of their role in contemporary practice.