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as you are an excellent urologist,i deeply need your help.

my name is david and i am 39 years old,.  3 years ago ,even though i had no erectile dysfunction whatsoever i did an injection of a vasodilator (a mixture of papaverine and phentolamine) and i noticed a strange erection (it was smaller and softer than my usual erections and a little bit curved to the left),and,this erection was not painful at all and it lasted exactly 6 hours ,then it went down on its own. and,since that incident my erections are much softer and smaller ,even with viagra 100 mg,so,i have been to many urologists who upon physical examination could not detect any damage whatsoever or plaques or scarring,and i also did:

  a penile duplex ultrasound, done 2 months after the injection and it was normal,and,exactly 2 years after the injection ,i did also another penile duplex ultrasound,and it was also with normal results, ( a PSV exceeding 35 cm/s,reaching during erection 72 cm/s,with no fibrosis,or scarring or plaques and,no evidence of a venous,i need to ask :

1) because the duplex ultrasound was twice normal,can i reassure myself and be confident that there is no  damage whatsoever   ( any fibrosis whatsoever,lesions,abnormal penile tissues  or any injury of any kind and no  scarring whatsoever caused by the prolonged erection),and,that my penile tissues are perfectly normal ,so i should be able to restore the same quality of erections i used to have prior to the injection....?

2) is there anything in the medical literature about a microscopic damage after a prolonged erection?,and, if there were,would it affect the quality of erections,or is it unlikely? it reversible on its own?

3) do u recommend a chronic use of viagra or cialis? and,to what extent would it be beneficial in reversing a possible mild fibrosis or a very mild damage (undetectable by tests...)?

4) can a chronic use of viagra or cialis reverse any possible injury in  the penile endothelial cells...or any mild sacrring in the corpora cavernosa?

   thank you DR LESLIE,

ANSWER: David:

The duplex ultrasound has demonstrated no vascular damage, but it does not measure possible tissue damage from the prolonged erection.  For example, fibrosis and scarring would not necessarily show up on ultrasound.  Neither would endothelial cell damage, nerve damage, etc.  In other words, you may or may not be able to restore your erections to their prior state.

Usually, priapisms or prolonged erections need to last more than 24 hours to be at significant risk of fibrosis and permanent damage, but that doesn't mean there can't be some level of damage with lesser durations.

There is no study on microscopic damage on priapisms that I am aware of.  each case is individualized.

Use of viagra or cialis has been recommended by some to increase blood flow and oxygenation, but there is also a risk of increasing the chances of another priapism in those who are susceptible.  Such a treatment might help borderline tissues but is not likely to cure or heal existing fibrosis.

There is no data to suggest that chronic use of viagra or cialis will reverse possible injury to endothelial cells although there is evidence that it can help in some situations such as after radical prostate surgery.

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

QUESTION: thank you DR LESLIE,for your very important and valuable reply,but,i need to sak:

1) if there were truly some level of damage in my case which was lesser than 24 hours,( exactly 6 hours),do u think a chronic use of cialis or viagra given my case should be beneficial ...?

2) for a chronic use,which one do u recommend that i use of either viagra or cialis,and for how long should it be used for optimal benefits...?

3) if fibrosis and scarring would not necessarily show up on ultrasound,then,what test can detect in an accurate way if there is any fibrosis and scarring ? and ,to what extent can a physical examination by a urologist detect fibrosis and scarring..?

 thank you DR LESLIE,


The answers to your questions are:

1) Maybe.  Ask your physician.

2) I prefer cialis due to longer duration and lower dosage.  There is no information available on optimal timing or duration.

3) There is no known test to properly identify fibrosis or scarring that is not identifiable by direct examination or ultrasound.  Theroretically, MRI might be used but since any findings would not affect treatment, this is not typically done.

Physical examination is only likely to find scarring that is thick enough to be palpable and located close enough to the surface so it can be felt.  


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Stephen W. Leslie, MD


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


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.

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

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.

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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