3 years ago, I had an unpainful erection which went down on its own after 6 hours; it was caused by an injection of a mixture of papaverine and phentolamine (even though I had no erectile difficulties). since that incident, the quality of my erections changed completely to become a lot smaller and softer even with 100 mg Viagra, as if my penis is not fully expanding, and while erect it is now curved about 15 degrees to the left, and the left side of my corpora is also twisted about 40 degrees to the left. I have been to many urologists and they could not detect any scarring after the priapism. So, I need to ask you:
All my hormonal blood tests were normal, and, my penile duplex ultrasound (done 16 months after the injection) was normal with normal blood flow ( PSV exceeding 35 cm/s, reaching during erection 77 cm/s, and no plaques or fibrosis or calcifications), and the cavernosometry with cavernosography was also strictly normal ,so, could I be confident that there was no damage or no injury whatsoever done from the injection, and, is the penile duplex able to detect any injury whatsoever after priapism? And, (in your huge experience) do you think that a possible minor damage (undetectable by duplex ultrasound) could occur, or is it unlikely?
The damage done with prolonged erection after injectable papaverine and phentolamine is likely ischemic damage done from deceased blood flow through the penis for an extended time. The damage can be on a microscopic level and may not always be seen on the standard tests used to work up patients with erectile dysfunction. The duplex ultrasound looks at the arterial supply in the penis. Arterial dysfunction is usually seen in patients with peripheral vascular disease (common with diabetes and coronary heart disease) and some patients who have experienced trauma to the penis.
Is the cavernosography able to accurately detect any possible morphological changes in the corpora cavernosa? And do you recommend that I try a chronic use of either Cialis or Viagra to see if it would be beneficial on the quality of my erections ( hardness and size and elasticity) and to restore the same quality of erections I used to have prior to the injection?
Cavernosometry and cavernosography tests look at the venous drainage of the penis and looks for places where previous trauma may have broken the corporal bodies or abnormal vein formation/dysfunction. Cavernosometry would be expected to demonstrate some abnormalities , but the exact area of the damage may not be seen on the cavernosography portion of the test. It may be possible that there is a very large number of small leaks that may not be visualized.
Cavernosography is best at showing a few large defects in the erectile bodies. The curving and twisting of the penis, however, would suggest that there has been some major damage to the penile tissues on a large scale. This should be felt with careful examination if it is causing dramatic bending and twisting of the penis when it is erect. The bending and twisting is due to the loss of elasticity of the tissue in the erectile bodies of the penis. These areas of abnormality should be seen on the cavernosography and be obvious when the penis is being expanded during the test if it is happening during normal erections.
There have not been any studies to determine if the use of the oral ED agents can reverse the exact damage done in this circumstance. We have found that long term use of these agents do improve the function of the erectile tissue over time in some patients but we have not determined which patients this works best for. I suggest visiting your urologist for more information.
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Published On: September 11, 2006