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Urology/Erectile Dysfunction after priapism

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QUESTION: Dear doctor,

hope u remember my whole case, no need to discuss earlier things, i can understand u that u r unable to determine cause of pain, but i dont have pain in my penis, there is difference between soreness and pain, back end of my penis is sore not regularly it shows soreness when i squeez it even after one year of priapism,

but u have not answered a very important doubt of mine

I HAD A FULL STRONG ERECTION ON NIGHT INTERVENING 20-21 SEPTEMBER 2013 I THEN MASTERBATED AND WAS VERY HAPPY THAT FINALLY I RECOVERED, I THEN HAD ANOTHER STRONG ERECTION NEXT NIGHT....IT WAS AFTER SIX MONTHS OF PRIAPISM... THEN I DONT KNOW WHY I DIDNT GET ERECTION AGAIN.  WHY IT STOPED AGAIN THIS IS QUESTION WHCH HAUNTS ME. CAN U SAY HOW I GT THAT STRONG ERECTION?????
ONE MORE THING MY PENIS DOES NOT RESPOND TO TOUCH LIKE IT USED TO, WHEN I TOUCH IT INSTEAD OF ERECTION IT SHRINKS....

ANSWER: Bilal:

I cannot answer your question in detail.  Variations in erectile response are not uncommon.  Damage after prolonged priapism is expected to some degree and healing takes quite a while.  It's impossible to determine what factors allowed that one good erection and it's promising as to your eventual recovery.  Most of the time, the variable factor is psychological or emotional and that could be the reason.  Check with your local physicians for additional help.

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QUESTION: Dear Dr.

Thank u very much for ur answer and words of encouragement, as u said that one good erection is promising that there is no irriversible damage in my penis, it releived me of vorries..... now one humble request how can i come to know what is the actual cause of ED right now my penis does not respond to touch, i try to masterbate some times but i dont get erection.... how can i come to know the cause...

thanks and regards

ANSWER: Bilal:

Essentially you know the cause which is the priapism.  If you want more details, this will take additional testing which is expensive, doesn't help with recovery, may not be covered by insurance and may not be available in your location.  To what degree will it really help you to know that the problem is more vascular than nerve or that there is endothelial cell damage since you can't do much about it?  That's why we tend to focus more on the treatment and are doing less diagnostic testing.

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

QUESTION: Dearest Dr,

I like ur approach to the highest extent,u r right basic cause is priapism , testing  and so on will really not help and is truely expensive... and u r very right it is not available in my place at all... i m thank full to u what u have said u r focusing on treatment instead of testing...
i have a request could u please brief me again about medicinal treatment....

thanks n regards
Bilal

Answer
Bilal:

Summary of Treatments for Erectile Dysfunction (ED)
In most men, the typical start of therapy for ED is medications such as Viagra, Levitra, Cialis and similar.  These act by blocking the activity of an enzyme in the penis resulting in higher levels of erection producing chemicals.  Essentially, these higher levels of erection producing chemicals are usually able to overcome the underlying problem but they arenít a cure; only a treatment.  Side effects usually include headache, indigestion, nasal stuffiness, flushing and infrequently a visual change.  Most need to be taken on an empty stomach and several tries are needed before we can assess the result.  If one pill doesnít work, we usually try at least one more as this causes success in about 50% of cases that fail the first pill!  Extremely rare incidents of vision loss and deafness have been reported, but there are less than 200 cases worldwide.  These medications can interfere with some heart medications, specifically nitroglycerine and similar cardiac nitrate meds, so they should never be taken by anyone regularly on such meds.  Higher doses than recommended typically donít work any better and only produce more side effects.
Other treatments include external vacuum devices, MUSE and penile injections.  The external vacuum devices use a small cylinder placed over the penis and then a small hand or battery powered pump sucks out the air inside the cylinder.  This negative pressure pulls blood into the penis and erection bodies creating a rigid erection.  A specially designed tension ring is then slipped onto the base of the penis to maintain the rigidity and the cylinder is then removed.  A maximum of 30 minutes is recommended with the tension ring in place before it should be removed. This device has several advantages. First, if it works at all itís likely to be highly reliable.  It is low cost as the initial purchase is often covered by insurance and subsequent use is quite cheap.  However, it requires plenty of lubricant to work properly and regular practice to get optimal results.
MUSE or Medicated Urethral System for Erection is a type of tiny urethral suppository.  This is found inside a small syringe that places the small, grain of rice sized medical suppository just inside the urethra.  The medication dissolves and diffuses into the erection bodies.  There can be some mild irritation at the spot where the suppository is located.  This is primarily chosen by men who are reluctant or canít use penile injection therapy.
Penile injections involve the use of blood flow enhancing medications directly into the erection bodies.  This is a very effective way to cause erections and the medications can be changed and doses adjusted as needed.  The injection is painless and the erections typically will last 60-90 minutes.
In some cases, we will use a combination of the above treatments to get an optimal result such as Viagra with MUSE or penile injection. This should only be done under direct physician supervision to avoid harm to the penis and unsafe, prolonged erections.
If everything else fails, then a penile prosthetic implant can be considered.

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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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