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 thank you DR LESLIE for ur reply,but i need to ask:
1) what percentage of rigidity is usually required in order to have a satisfactory erection,and,to be able to do a penetration?(is it 60 % or more....)?
2)supposing that one has an inadequate erection for penetration(for ex 50 % rigidity),so,what increase in rigidity percentage could one achieve if he uses viagra 50 mg or 100 mg?
3)is the use of MUSE safer than caverject in terms of preventing a possible scarring and fibrosis,and,does it have the same efficacy results as caverject?
thank u DR LESLIE,
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The text above is a follow-up to ...
-----Question-----
hi DR LESLIE,my name is rony ,37 years old,and,i need to ask:
1)through which criteria can one say that he has an excellent response to caverject injection?and,does an excellent response usually requires an erection of more than 70 % rigidity or what...?
2)can one do a penile duplex ultrasound (as a means to evaluate erectile dysfunction)without using an injection of a vasodilator,or ,is this injection necessary for the test to be accurate?
3)if a person fears injections a lot,so,can viagra or levitra be used instead of caverject during the penile duplex ultrasound,and,could the penile duplex ultrasound be as much accurate with viagra as with caverject?
thank you DR LESLIE,
-----Answer-----
The criteria is whatever the physician and patient decide it is. Generally, 70% hard with 50% being just hard enough, is usually sufficient for most people. I would call anything useful but less than 90-100% "sufficient or adequate" and reserve "excellent" for the 90% and better.
Penile duplex ultrasound is not particularly helpful without the vasodilator. It's not so much the accuracy as the test is reasonably accurate. It's what you are measuring. Non-dilated or relaxed blood flow is just not a useful indicator. It tells you that there is insufficient blood flow to cause an erection when there isn't an erection.
Yes, Viagra or Levitra can be used, but again you have the same problem in not getting any useful information. Viagra and Levitra do not produce a reproducible, definitive degree of vasodilation or muscle relaxation so you cannot make any definitive determination of the results.
If you are that scared of the injections, why do the testing? There is really very little point as it's intended mostly to document whether or not injection testing is useful as a therapy. MUSE can do much the same thing without the shot.
But we have gotten away from testing because it really doesn't help that much. We just go to the various therapies available and keep trying until we find one that works reasonably well.
By the way, the injections really don't hurt and people who try them find they aren't so terrifying after all. And penile injections are a good alternative therapy for ED.
Answer There is no set standardized degree of rigidity measurement. I use a 0-100 scale with 50% being just barely enough for penetration. According to that scale, 65-70% is usually satisfactory.
Likewise, there is no formula to determine how much of an improvement any individual will get with Viagra type medications. Either is helps enough, not quite enough or not nearly enough. When it's clear how well or not well it's working, adjustments or changes in therapy can be instituted.
MUSE has less incidence of scarring and fibrosis compared to Caverject although I've never seen a case where the scarring was severe or even noticeable. In general, MUSE is considered less effective than Caverject.
