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 andy ,and i am 38 years old.
i had a change in my erections since 9 months ago,and i noticed that my erections are soft and not very full even with viagra.so,i went to a urologist ,and i did a penile duplex ultrasound (caverject 20 ug was used during the test).and the test was normal:
a PSV exceeding 35 cm/s, reaching during erection 45 cm/s,with no signs of a venous leak and no fibrosis and no evidence of plaques.so,i have to ask:
1)even though my duplex ultrasound was normal,i got worried because my urologist told me ,that the PSV for someone my age ,should exceed 50 cm/s, is it true,because mine was 45 cm/s,and is there anything that i should be worried about?
2)despite the fact that the penile duplex ultrasound was normal,i do not have an optimal response to viagra,so,what could be its probable cause,and,do u recommend any additional test to be done?
3)to what extent can the penile duplex ultrasound detect any scar tissue in my corpora cavernosa,because i was told by my urologist ,that, if the duplex ultrasound did not detect any plaques or scar tissue,then, any possible scarring would have to be so minor and not significant at all?
thank you DR LESLIE,
Answer 1) No, it's nothing to worry about and it's not something you can change even if you wanted to.
2) Other causes for erectile dysfunction include medications, blood pressure problems, tissue injury or other endothelial disorders, central nervous system problems, hormonal problems, diabetes, psychological issues, etc.
We do not normally recommend ongoing testing except in cases where it's clear that Viagra type medications are not likely to work. A hormone level might be helpful in cases where Viagra is not working. Then we look at other treatments such as penile injections, MUSE, Vacuum devices, combination therapy with Viagra plus one of these other treatments, and finally implants. A nocturnal penile tumescence test is sometimes helpful in addition to the hormonal test and biothesiometry can be used to detect nervous system problems.
Duplex doppler ultrasound is used for blood flow determinations. It can also be used to screen for plaques but it has to be used specifically for that purpose.
