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Urology/Penile Injury - Follow Up


Dear dr Leslie,

I write in order to give you some follow up to my case of penile injury ( ) and ask you a couple of questions more. I really hope you can find the time to reply, since your answers last time brought me great relief to what has been the most stressful period of my life.

To sum it up, on March and during sexual intercourse with my girlfriend my penis was injured. There wasn’t any of the typical signs of penile fracture (bleeding, deformity etc.) except from great pain which lasted for days. After that my erection quality started to decline.

In the weeks that followed the injury, many strange and abnormal things happened regarding my penis function. While I wasn’t able to produce an erection, other than a semi-hard, with the common masturbation moves, during the night I had erections that seemed to last for hours and then, upon waking, they were leaving me with a dull, burning pain that was lasting for the most part of the day.

In addition to this, during these erections my penis was redder than normal and pulsating, like it was filled with more blood than normal.
Being in despair, I didn’t stop checking erections and the erections kept worsening. By May, night-time or morning erections ceased, while during the day my flaccid penis looked extremely shrinked, with the glans also shrinked and cold.

In the beginning of June, that is three months after the initial injury, I had a MRI and a Doppler test. Both came back normal, although the erection that I got from the low dose injection was half the normal size.

By the end of June and after being unable to have an erection for over a month, I tried for 5 days a daily cialis of 5mg. The results seemed like a miracle. All of a sudden my penis started to get erect to the littlest stimuli and this effect lasted in its full force for well over a week after I took the fifth and last pill.

By that time I wrote you for the first time. Now 2 and a half months have passed.

In these months I started pentoxiphylline which I still take 3 times per day. The quality of the erections has improved, although it is still far from normal, while some strange things still persist.

  - After an erection the penis stays in a semi hard condition for quite a time.

  - When I go to the toilet after an erection, often the urine stream splits.

  - Sometimes my erections exhibit the old, normal size and shape, while other times they are narrower and weaker. In addition to this, when the penis is semi-hard it curves a lot, but the curve disappears when it gets fully erect.

  - Morning erections have reappeared but not consistently.

  - Finally, I restarted daily cialis of 5 mg, which I now take continuously for 3 weeks. However, this time its effect is nowhere near to what I got in the first time. It gives me a fuller and healthier looking flaccid penis, but I have nothing like the extremely easy arousal and erections I got in the first time.

This has puzzled me a lot, since I was hoping that now that erections have improved,   cialis would get me a better response than that of 2 months ago, when I was practically impotent.

So my questions are these:

  1. Judging by my description and your experience, what do you believe was the reason behind my diminishing erection ability weeks after the initial trauma? These long lasting nightly erections that were followed by a dull, burning pain could had been short episodes of some kind of priapism?

  2. Why sometimes my penis exhibits its normal size, while other times it is narrower? Is this a sign that there is no permanent damage to the erectile tissues or vice versa?

  3. Why sometimes urine stream splits and other times not? What may be the cause?

  4. After the injury and until a few weeks ago, when I ejaculated only a few drops of semen were dripping. Now this has come back to normal and I ejaculate like I used to be. What could be the reason for this?

  5. How come when I took cialis for a few days to have such great results and now, 2 months later and while I am on it for three weeks, its effect is nowhere near?

  6. I feel that things are slowly improving but this improvement doesn’t seem linear. Can this be the case, or should it be linear to be sure that I improve?

  7. On the fourth month after the injury (July), I visited an urologist who didn’t find any scar tissue upon examination. He told me that if it was for scar tissue to be formed, it would have been formed until then. Is this reassuring that things will not get worst, but improve?

  8. You had told me that a combination of pentoxiphylline and cialis sounded reasonable to you. Now I take pentoxiphylline for 10 weeks and cialis for 3. For how long should I continue this regimen according to your opinion?

  9. You had given me a time frame of one year for recovery. Judging by my “progress”, could I be optimistic that in the following 6 months I can recover more? I ‘d like to think that now that I get more erections and my penis looks healthier, the healing process could speed up. Is this reasonable?

  10. Finally, is there something else I could do to help recovery?

I am very thankful you got through this long text. I tried to give you all the details. I would be extremely obliged if you could answer all these questions to your best judgment.

Your reply the other time gave me courage to get through all this and was much more insightful than anything I heard from my local urologists.

Thank you,


The purpose of this forum is to give general answers to urological questions and not to be a second opinion or treating source for complicated problems.  However, I'll try to answer some of your questions.

The reason for the change in erection function is unclear.  It could indicate scarring, new injury or psychological/anxiety issues.

The apparent change in size from normal to narrow is likely just perceptional.  Any true problem would tend to be permanent.

Urine splitting is usually related to the size and shape of the last 1 inch of the urinary tube.

THe reason for low ejaculate volume was probably retrograde ejaculation which has now healed.  The exact reason for this is also unclear.

Effect from Viagra and Cialis is very subject to anxiety and psychological effects as well as hormone levels.

There is no general consensus on how this should heal.  While it typically heals more or less linearly, there are no guarantee and it can be all over the place.

Scar tissue can form anytime and may not be identifiable on a physical examination.

If the current combination of cialis and pentoxyphyline is not helping, at some point you may want to stop one or both.  It sounds like things are helping at least a little so I suggest you continue.  Your local physicians will have to guide you on this.

You can predict recovery rate at this point better than I can.

It is not unreasonable to believe that on the best available treatment, things can continue to slowly improve.  Good luck.  


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


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.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

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.

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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