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Urology/follow up question. doppler test and weird symtpoms

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QUESTION: sorry dr.leslie i posted a follow up question regarding penile doppler test but i guess the question was not clear.

i am 31 years old male who has trauma to penis/lower abdomen (pubic area) several months ago. ever since then having erectile dysfunction issues and priapism type of problem.

i saw several urologist and did penile doppler test

results came back as PSV on both sides come back as 28. EDV being 0.

from what i was told in normal male in 30s average PSV is above 35cm/s
anything between 25-30cm/s is indecisive, and anything under 25cm/s is considered arterial insufficieny Erectile dysfunction.

Is this correct? your previous answer said 10-15cm/s is normal range..

this might sound odd/weird, also everytime i sleep/nap i am getting these semirigid erections for hours.
ive been suffering for 4 months now and everyone thinks i am crazy.
Cant fall asleep and waking up every night every several hours because of these semirigid erection but they are not painful.

ive been to numerous urologist and theyve been no help.

i am desparate and exhausted. any help would be appreciated or recommendation would be greatly appreciates

ANSWER: John:

The normal range given was for the flaccid penis.  In general, a PSV less than 25 cm/sec is considered diagnostic for arterial insufficiency. Many urologists feel that to be completely normal, the PSV should be 35 or more.

Here is a reference that goes into greater detail on diagnosis of this problem.

http://www.imop.gr/sites/default/files/leroy_2011.pdf

As far as your current problem, a combination of priapism with ED is extremely difficult to treat.  If we treat for ED, the priapism could get worse and vice versa.

My only suggestion is to get an opinion from a urology expert in men's health at a tertiary care university hospital center.

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

left leg inner vein
left leg inner vein  
QUESTION: thanks. have you seen cases like this before?  i consulted another urologist and he says if there is venous block/drainage problem at upper area (pudendal/iliac/leg vein) it could back up the bloodflow giving a low PSV. is that possible? i thought PSV measure artery inflow. could it be affected by blocked or abnormal vein? (he wasnt sure if that can happen)

the reason for asking is ive been randomly getting pain (not excuricating but sometimes bothersome) next to pubic bone just next to where leg splits from groin. also subsquently few weeks after the incident my left leg developed profound appearance as seen on attached image. sometimes sore when i touch the upper area where vein starts to show. there is very small bulge.

thank you so much for your help. i am just so lost what to do and suffering for months. any help would be greatly appreciated.

Answer
John:

I am reasonably sure your pain is not related to blood flow into the penis.

I have seen many cases involving ED and blood flow, but none exactly like yours.

PSV measures arterial blood flow.  Even if veins are blocked (rare and unlikely) it should not affect the PSV very much if at all.  You may want to check with your local general physician about the possibility of blood clots or similar problems.  

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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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