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Urology/Venous leak?


- I have been afraid that I have venous leak for some time. About year ago I had a doppler exam and everything was fine, when stimulated with alprostadil the results were: PSV: 79/56 cm/s and EDV: negative/negative.
 Almost a year from this my erections have been weaker and they don't even keep up so well. I also dont have so much morning erections anymore, or they're not that hard. I'm not sure if this is caused by my anxiety about venous leakage (or anxiety that the erection dont keep up), or my prostatitis, or my discontinuation of ssri-medicine last summer.
 I think I get little anxiety when I have an erection, I start to think about does this erection keep up, and little while after that I sometimes/usually can feel this kind of heavy heartbeat pulsating in my body, the hearbeat isn't fast but its heavy/hard. I still got couple of good morning erections about 1-2 months ago. And I can masturbate to orgasm while I still have problem of getting aroused and a bad libido (maybe from ssri-meds?), but I can last only about 1-5 minutes so It doesnt rule out venous leak or does it?
 So my question is that how possible do you think that it is that I have venous leakage when my test results were that good about year ago and there haven't been any damages or traumas to my penis after that? Do you think that there might be some other reason to these bad erections? Can venous leakage happen by itself in a year without any trauma considering that things were so good a year ago, is it common that it happens by itself without any damage?

Ps. I'm 25 years old, I dont have diabetes. I recently got my testosterone levels measured and it was about 14 nmol/l, couple of years ago I had about 20 nmol/l, but my doctor said that the levels can change even on daily basis etc. (maybe the ssri-treatment has changed my levels?)

Thank you alot for your answer!

Dear Sam,  Often men write to me with medical questions without first seeing a doctor.  However, I occasionally get questions from men seeking a second opinion when it is clear they have seen one or more Urologists, including sub-specialists, and have had testing.  In my own practice, I see men seeking second opinions.  However, I have the ability to review their records, examine them etc.  I do not have that ability at AllExperts.  In your case, I really can not give you a meaningful answer.  When you ask "is it possible that you may have a venous leakage", the answer is yes, it is possible.  If you ask if your erection problems could be from some other cause, well, sure.  However, I do not think these answers really effectively address your concerns.  In your case, I just do not think the internet will provide you with an effective substitute for a second opinion.  In general, I will tell you that most Urologists do not spend too much time contemplating the cause of ED or pursuing testing (there are exceptions).  That is because in general, in most cases, the approach is to focus on treatment with the goal being to identify the least invasive treatment that provides a satisfactory result.  Best of luck.


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Joel Gelman, M.D.


Urethral Stricture Disease, Peyronie's Disease and disorders of penile curvature, Erectile Dysfunction with a focus on penile implant surgery, Male Incontinence, Hypospadias


Dr. Gelman is a Board Certified Fellowship Trained expert in Male Reconstructive Urology and the Director of the Center for Reconstructive Urology in the Department of Urology at UC, Irvine Medical Center.

American Urologic Association Society of GU Reconstructive Surgeons (Board of Directors) International Sexual Medicine Society Western Section, Americal Urological Association

Journal of Urology Urology Journal of Endourology

Residency in Urology, UCLA, completed 1995 Fellowship in GU Reconstruction, Devine Center, completed 1997

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The Center for Reconstructive Urology is a regional, national, and international Tertiary Referral Center for urethral stricture disease, penile curvature, erectile dysfunction, male incontinence, and other surgical disorders of the male urethra and penis. Patients have travelled from 24 different states and other countries to receive care at the Center for Reconstructive Urology. More information can be found at

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