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Urology/Penile Duplex

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QUESTION: Hello Doctor,
I have been having weak erections as well losing erections fast.
I done a penile duplex and the report conclusion suggest a venous leakage although after my urologist saw the report he claims it is very normal to have such small leakage and we should not worry and i can continue in my marriage plan which should due in next 2 months.
My urologist said my case is minor and should be resolved with normal pills like Viagra meanwhile he gave me some dietary supplements as well some herbs then should see him in a month. may you please take a look at my Doppler and confirm if it is really that minor or should i see another urologist please ?

Examination In FLACCID STATE: revealed:-
-Both corpora cavernosa are homogenous with no areas of fibrosis.
-Cavernosal arteries:
Right cavernosal artery:
Diameter = 0.6mm
Maximum systolic velocity = 7cm/sec
Left Cavernosal artery:
-Diameter = 0.6 mm
-Maximum systolic velocity = 9cm/sec

Examination after I.C.I of prostaglandine:-
-clinic reponse to prostaglandine: elongation with moderate erection (E3)
Cavernosal arteries:
Right cavernosal artery:
-Diameter = 1.2mm
At 5 minutes
-peak systolic velocity = 59.4 cm/sec
-end diastolic velocity = 10.5 cm/sec
-RI = 0.82
At 20 minutes:
- peak systolic velocity = 94.2 cm/sec
- end diastolic velocity = 8.7 cm/sec
-RI = .91
At 30 minutes:
-peak systolic velocity = 46.4cm/sec
-end diastolic velocity = 4.2cm/sec
-RI =0,91

Left cavernosal artery:
- Diameter = 1.6mm
At 5 minutes
-peak systolic velocity = 47.7 cm/sec
-end diastolic velocity = 10.8 cm/sec
RI = 0.74

At 20 minutes:
-peak systolic velocity = 34.2/sec
-end diastolic velocity = 1.3 cm/sec
RI = 0.9

At 30 minutes:
-peak systolic velocity = 86.1cm/sec
-end diastolic velocity = 8.2 cm/sec
RI = 0.9

Conclusion:
- normal duplex examination of both cavernosal arteries
- increased end diastolic blood velocity at both sides suggesting venous leakage

Thanks a lot
Ahmed

ANSWER: Ahmed:

We don't typically do second opinion interpretations of test results.  We would not have time to do anything else!  Your history is consistent with a mild case of venous leakage and the treatment plan suggested by your urologist is reasonable.  However, if you want another opinion, you can certainly see another local urologist.

---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Stephen,
Thanks for your time and I am sorry if i violated the policy for this generous  helping service. I really didn't mean to.
I really went to 2 urologist and they said the same opinion yet i still feel i am not well and really afraid to proceed in my marriage.
I was willing to see another opinion aboard my country if needed to ensure i will not screw my future wife life, she really does not deserve this.
not sure if this will violate the policy but If you can point me to a place even paid service who can take a look at my tests that would be really very kind of you.
Thanks for your time , really appreciated
Ahmed

ANSWER: Ahmed:

My sincere advice is as follows.  FORGET ABOUT THE TEST RESULTS!  All that's going to do is get you more anxious.  It probably should not have been done in the first place because it does not change your situation or help with treatment.

The only real question is whehter or not your erection function is adequate.  If it is, don't worry about it.  If not, then the issue is which therapy works best for you: viagra or similar medications, MUSE, penile injections or external vacuum systems.  Concentrate on the result and don't worry over a diagnosis which will not help.

---------- FOLLOW-UP ----------

QUESTION: Many thanks doctor Stephen for your kindly assistance.
I do really appreciate it very much.
Just please I do need your opinion about one thing please, my local doctor gave me Viagra 25mg for a trial, really it gave me a very hard erection when I am sitting down , I could keep my erection without even stimulation or anything for long time , yet i do lose my erection once i do stand up, does that make sense please ? could venous leakage increase when standing up to a degree that make me lose the erection i can keep easily when sitting ? my local doctors said this is not possible and venous leakage rate doesnot change with changing positions such as standing and all in my mind as i try to stand to see if it will stay hard then my mind makes me lose it in seconds, what is your opinion on this please ? can venous leakage increase with standing ? or is it all in my mind really ?
I do really appreciate your kindness and great support and your time indeed.

Answer
Ahmed:

Loss of erection when changing position is not uncommon.  It has to do with diversion of the blood supply.  Standing up requires blood to flow away from the penis to the large muscles of the lower back and the buttocks so there is less blood flow to maintain the erection.  Your doctors are right that any venous leak problem would not change with position.

Since you're having a good response to viagra 25, you might want to try viagra at 50 mg as it may be able to overcome this problem with standing.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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