AboutArthur Goldstein, M.D. Expertise Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations American Medical Association, American Urological Association, American College of Surgeons
Question There is no need to reply/answer this reply. This is a reply only, to sum up what occured and I also suspect you may want to check out the paper on ketoconazole I reference at the end of this reply, since it is relevant to your profession.
Thank you, once again. I did call, and they physician on call did not think ejaculation itself would be harmful, but thought that the extended time period erections could be potentially harmful. I did end up ejaculating, and as you suspected, it was painful[rather high on the scale, subjectively, but I suspect this was partially due to the of the amount of built up semen and high force after the many hours of erections/sexual frustration]. However, the relief of the [painful] erections made it a worthwhile event.
RE: the last followup concerning drugs to induce impotence. I could not find reliable information on saltpeter(potassium nitrate) to suggest it was a useful impotence inducing drug. The only drug of which I am aware of at the moment that that can reliably induce such reaction[according to at least prelimary trials[1]] is ketoconazole, when given in sufficient dosages. Unfortunately, my reactions to this drug are 'severe' even in small dosage, therefor it is a useless drug for me.
-Chris
[1]Use of oral ketoconazole to prevent postoperative erections following penile surgery
International Journal of Impotence Research
K C Evans, A C Peterson, H E Ruiz and R A Costabile
August 2004, Volume 16, Number 4, Pages 346-349
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Thank you for the prompt response. What would probably happen if I ejaculated with a catheter in place(it is a 14F Foley)? So far as ejaculating, you seem mainly concerned about the muscle contractions. But where will the semen go? Won't the pressure itself be significant / potentially damaging? BTW, I tried e-mailing my surgeon but I got an AUTORESPONSE that he will not be available until Oct. 31st - he is out of town.
-Chris
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Chris, it would be preferable not to have erections as they theoretically could stretch the graft but probably will not harm it. Other than tring to change you thoughts (as you are doing) and using ice there is a old medication called salt peter that was used years ago in the military for this purpose but I have no experience with it. I am also unaware of its potential toxicity. There are many medications that as a potential side effect MAY cause erection or ejaculatory difficulty but this is not their primary mode of action and the incidence of this effect is relatively small. I would try to avoid ejaculation as the contraction of the pelvic muscles associated with this could possibly be harmful to the graft. You need to contact your surgeon for his advise on this matter. He apparently does a great deal of this type of surgery and perhaps can give you more specific advice or reassurance that it may not necessarily be harmful.
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Chris, surgeons have covering physicians attending to their practices while away. I suggest calling his office so that you can speak to/or see that physician. If you ejaculate with the catheter in place it would probably be most uncomfortable as the catheter would be squeezed against the interior of your urinary tract. You might note pain and/or bladder spasm and an intense desire to urinate. Most of the semen would come out around the catheter while some could pass backwards into the bladder (not harmful). It basically takes the path of least resistance. The muscle contractions, pressure of the catheter on the lining of the urethra, and increased pressure inside the urethra could all potentially damage the graft site.
Answer Christopher, I am glad you are feeling better. Thanks for the update on ketoconazole. Actually there are several articles on the use of this drug for the purpose of preventing post-op erections. Although I retired 5 years ago from active practice, I still try to keep up with the literature. This one, however, slipped by. I shall add it to my memory bank! Thanks.
