AboutStephen 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 20 years experience. Assistant Clinical Professor of Urology at the Medical College of Ohio. Editor in Chief of eMedicine Urology internet textbook. Author of only 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.
Question hi DR LESLIE,
my name is roger and i am 38 years old. 3 years ago i had an erection of 6 hours ,after i had an injection of (papaverine and phentolamine),the erection lasted exactly 6 hours ,then,it went down on its own,and,during this erection i did not feel any pain whatsoever.but,since that incident,my erections have become much smaller and softer even with viagra ,i feel as if the morphology and structure of my penis has utterly changed.i have been so far to many urologists and i also did a penile duplex ultrasound with normal results,and,all the urologists i have been to are not convinced that the shape and structure of my penis had changed post the injection,and,they r assuring me that there is nothing wrong(due to the results of the duplex ultrasound).but,i am still very convinced that the structure and morphology of my penis did change a lot after the injection,and,this could be the reason why i may have this poor response to viagra,but,the urologists said that this should be excluded because i have a normal penile duplex ultrasound.and,i have been told that the only way to find out if something really happened is by performing a penile biopsy,but,my urologist does not recommend it as it is an invasive procedure.but,i need to ask:
1)can the penile biopsy (in my particular case)be useful in detecting if there was any possible alterations in my penile ultrastructure(smooth muscle content,a mild fibrosis,etc..) and morphology,which could have happened post the injection?
2)is this biopsy safe or is it usually risky,and,do u recommend it in my case,or,there is no need to,because the duplex ultrasound was normal?
3)supposing there was any possible alterations in my penile ultrastructure post the injection,to what extent can the chronic use of PDE5 inhibitors reverse it ...?
4)even though my total and free testosterone are normal,do u think that some extra testosterone could be useful in restoring the penile ultrastructure and morphology that i used to have prior to the injection?
thank u DR LESLIE
Answer Yes, a penile biopsy may be useful in detecting morphological changes in the erection tissue. But so what? We do not have any surgeries or medications that can change this so why bother checking?
Penile biopsies are safe but rarely performed for the reasons mentioned above. I would not recommend it because it will not change your treatment.
It is not known if PDE5 inhibitors can change or diminish damage to the penile tissue. My guess is probably not.
Extra testosterone is NOT going to help if your natural levels are normal.
