Urology/prolonged erection, mild fibrosis
QUESTION: Hello DR LESLIE,
my name is David,I am 41 years old. 4 years ago I had a prolonged and non painful erection of 6 hours caused by an injection of a vasodilator,papaverine and phentolamine,the erection was flaccid on its own after 6 hours. after that incident my erections became softer and smaller even with 100 mg viagra. 2 normal penile duplex ultrasound were done the first one 2 months after the injection ,the 2nd one 1 year after the injection. 9 months ago I noticed a curvature of about 15 degrees to the left ,and the glans is also curved to the left .I went to a urologist who upon physical examination detected a mild fibrosis ,and said to leave it, as it will not affect my erections in any way,as for the curve he said it is mild and advised me to leave it alone also.so,I need to ask:
1) can a mild fibrosis affect the quality of erections,if so,in what way? Can my curvature of about 15 degrees interfere with penetration?
2)do u think that my curvature is probably caused by the possible mild fibrosis ,knowing that there is no plaques,and no peyronies disease?
3) Can a chronic use of viagra reverse a mild fibrosis? If not,what drug can clinically be useful and reverse a mild fibrosis,?
THANK YOU DR LESLIE,
Usually a "mild" fibrosis is not likely to affect erections.
For most people, a 15 degree curvature is not sufficient to interfere with intercourse but only you can determine if it's a problem for you or not.
Based on probability and guesswork, the fibrosis is the most likely cause of your curvature.
Chronic use of viagra cannot reverse fibrosis and neither can any other drug known. There has been some evidence for trental and carnitine as possibly being helpful in peyronie's, but nothing definitive yet.
---------- FOLLOW-UP ----------
QUESTION: Thank you DR LESLIE for your reply,but I need to ask:
1) I am planning to use a PDE5 inhibitor in a chronic way,which one do u prefer of either cialis,levitra ,or viagra
and why? And what are the clinical benefits of chronic use of PDE5 inhibitors in terms of microcirculation,penile tissues and endothelial cells?
2) do u recommend that I take trental and acetyl l carnitine for few months?
3) do u recommend that I use a vacuum erection device daily as a massage to the erectile tissues to probably reverse curvature and fibrosis?
4) do u think that a new duplex ultrasound must be done to detect any abnormal tissues or the possible mild fibrosis?
Thank you DR LESLIE,
I tend to recommend cialis because it can be taken 5 mg daily. There may be some benefit in chronic use as it should improve oxygenation and blood flow. The exact nature and degree of the benefit is unclear.
Taking trental or carnitine is an issue for you to discuss with your physician.
I have not been impressed with the use of external vacuum devices for reduction of angulation. It certainly does not reduce fibrosis.
I do not see any clinical benefit in repeating the duplex ultrasound.