Can anybody interpret my Doppler test result.

[shrunken_dick]

I have severe erectile dysfunction along with major shrinkage. My Doppler test says no Erectile dysfunction. I want to know opinion of Veterans on this board. Here is my test result.

PSV / EDV ( cm/sec) / Time after Papaverine injection

In right erection chamber

20/3/at rest 51/-2.5/5 min 35/-8/10 min 38.8/0.4/15 min 47/-9.3/ 20 min 30/4.6/25min 34/5/30 min

In left erection chamber

22/5/at rest 33/0.8/5 min 72/-7/10 min 38/1.7 /15 min 59/1.2 / 20 min 40/4.2/ 25 min

35/0.4/30 min

[Nadie123]

Well, I also had a penile doppler ultrasound, and it gave "positive" results, the test was performed with a half-numbed penis, it was not an erection or 60% so I doubt the quality of it .... (an inexperienced radiologist in dopplers) .... Currently I do not respond well neither with cialis nor with viagra (one year after the doppler) another reason to think that the doppler was not done in a good way .... in conclusion the doppler ultrasounds They must be carried out by experts in that subject of the penis and they are not very reliable, cavernosographies are more reliable

[shrunken_dick]

Can Cavernosography detect mild corporal fibrosis?

[Fed1981]

I have severe erectile dysfunction along with major shrinkage. My Doppler test says no Erectile dysfunction. I want to know opinion of Veterans on this board. Here is my test result.

PSV / EDV ( cm/sec) / Time after Papaverine injection

In right erection chamber

20/3/at rest 51/-2.5/5 min 35/-8/10 min 38.8/0.4/15 min 47/-9.3/ 20 min 30/4.6/25min 34/5/30 min

In left erection chamber

22/5/at rest 33/0.8/5 min 72/-7/10 min 38/1.7 /15 min 59/1.2 / 20 min 40/4.2/ 25 min

35/0.4/30 min

Ok, my interpretation of the above:
1. Your PSV is good as it gets up to well over 30cm/s during erection phase in both right and erection chamber. The typical cut off for arteriogenic dysfunction is PSV maintained at <30cm/s although some physicians go by <25cm/s
2. Similarly, your EDV values are reassuring. This is the aspect of the test that looks for venous leak by assessing for absence of "reversal of diastolic flow". Essentially, you want reversal of diastolic flow which = minimal blood leaking out during erection. Generally, the consensus is that an EDV <5cm/s excludes venous leak. On your right side, the EDV only approaches 5cm/s by the 30min point of the test which I consider to be normal and it remains in negative numbers almost the whole time prior to that. On the left side, again, the EDV remains <5cm/s throughout the doppler. This section of the test essentially excludes venous leak in your case.

Ultimately, the USS doppler is reassuring and does not suggest either arteriogenic or venous impotence from what I understand. I am sure your Doctor can give you an interpretation however as I am in no way saying my feedback is a substitute for professional medical advice (and I don't want it to be taken as such). I am just giving my opinion based on what I understand from my reading about penile USS doppler (as I have had 2 myself).

Hope that's helpful!

[shrunken_dick]

@Fed ; Thanks for helping. My doctor says no sign of venous leak. I wonder what is causing this severe erectile dysfunction in me. I can barely get hard and I have loss of length and girth. My flaccid looks a lot smaller.

[Fed1981]

@Fed ; Thanks for helping. My doctor says no sign of venous leak. I wonder what is causing this severe erectile dysfunction in me. I can barely get hard and I have loss of length and girth. My flaccid looks a lot smaller.

Well I think you have essentially excluded vascular causes with your doppler results which is a great start!

Given your age and USS doppler result, I would imagine you can also exclude structural causes (i.e. peyronie's, corporal fibrosis, penile fracture) as these would normally show up on an USS doppler and corporal fibrosis would be unlikely at your age (unless you had suffered with severe, long-lasting priapism which I imagine you haven't).

Therefore, you are essentially left with a few other possible causes:
1. neurological - I don't know if there is any reason for this in your case but typically this is seen in post-prostatectomy patients who have had their neural bundle damaged through surgery. Other groups may be those with chronic degenerative neurological disease such as MS (multiple sclerosis), those with spinal cord injury or small fibre neuropathy/damage in diabetes for example. I imagine none of these really apply in your case either.
2. psychological - truly a lot more significant than people think and can mimic physical causes (even in severe cases) until the underlying psychological issue is resolved.
3. Hormonal - e.g. low testosterone but usually not significant enough to cause severe ED and more likely to affect arousal and libido. Over time, due to a lack of good erections can potentially lead to structural changes but this would happen over years to decades most likely.
4. Muscular - CPPS/prostatitis/hard flaccid, whatever you want to call it, is a real entity and gaining traction in the medical world. Especially in younger patients who suffer with ED and struggle for months and years looking for a diagnosis I think this is worth looking in to. I truly believe there may even have been young patients with normal USSs, MRIs but with persistent ED with no identifiable cause. They may have gone on to have penile implants when in actual fact they were suffering with pelvic floor dysfunction, sympathetic hyperactivity and concomitant psychological distress - all correctable albeit over time albeit with hard work and commitment.

In my case, I have been suffering on-and-off with ED since using a VED in mid-2020. For many months I believed I had caused permanent structural damage/scarring and would never recover. Nevertheless, in the subsequent months I started to work on stretching and then pelvic floor work with a physio and began to notice improvements; I believed I had potentially over-exerted some of the pelvic muscles involved in erection by applying external pulling forces with the VED (i.e. ischiocavernosus and bulbospongiosus). Incrementally, my erections improved and then I started to have weeks where they felt almost back to normal. Basically, once I started having normal erections again I knew it couldn't be something permanent or structurally wrong with my penis itself because the body doesn't work like that - i.e. oscillate between abnormal function and normal function within a matter of days. So, in my case, I will continue working with pelvic floor physio and on reducing my stress/anxiety and improving my mental health. I am not saying this will work for you or everyone, I just think it should be considered high up on list of possible causes in younger patients. I have a horrible feeling that many younger guys (without vascular or structural abnormalities on USS and MRI) could go through irreversible surgical procedures when they potentially have a curable condition secondary to pelvic muscle dysfunction and co-existing psychological distress!

[bldoink]

Wow, Fed1981,
IMHO, that was a very good and needed post. I wonder if it would be wise to rewrite it as a more general/generic post and made into a forum sticky?

[ViaSwiss]

I posted a similar thread and an answer in it

viewtopic.php?f=6&t=16261

[Simbarn]

@Fed ; Thanks for helping. My doctor says no sign of venous leak. I wonder what is causing this severe erectile dysfunction in me. I can barely get hard and I have loss of length and girth. My flaccid looks a lot smaller.

Well I think you have essentially excluded vascular causes with your doppler results which is a great start!
In my case, I have been suffering on-and-off with ED since using a VED in mid-2020. For many months I believed I had caused permanent structural damage/scarring and would never recover. Nevertheless, in the subsequent months I started to work on stretching and then pelvic floor work with a physio and began to notice improvements; I believed I had potentially over-exerted some of the pelvic muscles involved in erection by applying external pulling forces with the VED (i.e. ischiocavernosus and bulbospongiosus). Incrementally, my erections improved and then I started to have weeks where they felt almost back to normal. Basically, once I started having normal erections again I knew it couldn't be something permanent or structurally wrong with my penis itself because the body doesn't work like that - i.e. oscillate between abnormal function and normal function within a matter of days. So, in my case, I will continue working with pelvic floor physio and on reducing my stress/anxiety and improving my mental health. I am not saying this will work for you or everyone, I just think it should be considered high up on list of possible causes in younger patients. I have a horrible feeling that many younger guys (without vascular or structural abnormalities on USS and MRI) could go through irreversible surgical procedures when they potentially have a curable condition secondary to pelvic muscle dysfunction and co-existing psychological distress!

Excellent logical post Fed. Thank you for your explanation of the doppler results as well. Good to hear you will continue to work on the pelvic floor issue. The oscillating between normal and abnormal function was certainly a strong indicator of where the problem may lie.
I do agree that some young men may have had those surgical procedures unnecessarily. One cannot underestimate the effect of anxiety as you mention.

[shrunken_dick]

@Fed ; My left erection chamber towards the base is not inflating, which is costing me at least 1/2 inch erect length. When I get an injection, the curve becomes obvious. The radiologist who did my Doppler test said that the curve is not significant and isn’t a cause of my ED.