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Urology/Venous leak controversy

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QUESTION: Dr.

I asked a question to both you and the other Dr on this site, both of you had knowledgable answers. However , dr Goldstein said having an intermittent problem with an erection doesn't necessarily rule out venous leak. You said if you had venous leak it would be a consistent issue and you couldn't maintain hard erections with masturbation.  A few other urologists I've talked to have all said if you had venous leak it would be a 24/7 issue that wouldn't vary regardless of the situation.   What's the truth ? I got paranoid about venous leak after hitting the area several months ago, there was no bruising or swelling and I've had hard erections and sex many times since , with a loss of an erection a couple random times with sex only, the first time was after having good intercourse about four times after hitting the area before a random loss of erection , never had one with masturbation.  Multiple doctors have also said the trauma i described wouldn't create any leak. I also had superficial vein thrombosis a month after hitting the area and was told by multiple urologists that this doesn't effect erections and wouldn't create a leak and isn't related to hitting the area . You're probably asking why does it matter but to me it seems there is some controversy surrounding this entity. I hope you can clarify further.

ANSWER: Ken:

Obviously I'm going to say that I'm right and he's wrong.  Any physical problem is likely to be relatively constant.  An intermittent problem would tend to indicate something that is relatively normal today and abnormal tomorrow.  Does that sound like a permanent problem like a venous leak to you?

It may be possible for very positive factors to overcome venous leak from time to time, but it's still a physical issue and would therefore typically be relatively constant.

Venous leak is thought to be due to structural changes in the erectile tissue although it is possible for trauma to cause similar changes.  

Superficial venous thrombosis is unrelated to ED or to venous leak.

Since there is no specific treatment for venous leak, it's purely academic.  Your level of intermittent performance suggests a non-physical factor such as anxiety.

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

QUESTION: Dr.

Ok thanks.  In your opinion what degree of trauma could create venous leak. I asked a few other urologists and they seem to agree that it would have to be severe trauma such as a penile or pelvic fracture . I know there's no way go measure it but what's your opinion.  There was no bruising or swelling after when I hit the area and it hurt for 20 min mainly right above the penis. I was able to get a full erection within the hour and I had good intercourse within a week or two later .

Answer
Ken:

How can I measure the degree of trauma to you?  A level 10?  Intermediate to Severe?  In my opinion, it would take a fairly substantial degree of trauma that involves a substantial portion of the penis.  With all the cases of ED that I've seen over the years, this would be quite infrequent. The relatively minor trauma you've described would not lead me to think that it would produce a venous leak (good immediate erection shortly after the trauma and afterwards).

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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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