Doppler Shows Venous Leak - Worried of Options

[Ahchuykak]

Hi everyone,

First of all, I want to say this forum is a godsend. It’s not easy to talk about these things, and seeing others share their stories has helped me feel less alone. So I wanted to share mine and hopefully get some guidance from the more experienced guys here.

I’ve had some degree of ED since my early 20s, but it wasn’t a major issue until I hit my early 30s . That’s when I started using Cialis, which worked really well for about 6-7 years. (I am 38 now) But then started to become less effective.

I saw a urologist who put me on a few rounds of P-shots (the Priapus Shot). Unfortunately, it didn’t do much for me—maybe a slight placebo at best. He thought things might be more serious and sent me for a penile Doppler.

Here are my Doppler results:

Injection: 16 mcg prostaglandin

PSV (Peak Systolic Velocity):

Right Cavernosal: 92–96 cm/s

Left Cavernosal: 88–102 cm/s

EDV (End Diastolic Velocity):

Started at : 18/9 cm/s (Right/Left)

Dropped to : -10/-12 cm/s at 15 minutes

Then changed to: -8/-7 cm/s at 20 minutes

Erection Quality: Full rigidity observed (Grade 3), but erection only lasted about 10 minutes before decline

Conclusion: Mild and short-duration venous leak episodes observed; some inconsistent veno-occlusive function (i think my numbers dont match it but he observed it and i did lose the erection rather fast after getting up)

After getting these results, the doctor recommended stem cell therapy. I went ahead with it, but honestly, it seemed useless in my case. Later on, I tried shockwave therapy—maybe there was a slight improvement, but nothing major.

Around the same time, I also started experiencing nocturia and eventually found out I have a high bladder neck. My urologist prescribed alfuzosin, which surprisingly helped a lot with the erections at first. Unfortunately, that effect also wore off over time.

I should also mention I live an extremely healthy lifestyle—zero alcohol, clean diet, regular exercise, and good sleep. So I’ve tried to optimize everything I can on my end.

I am scared to get another Doppler because if confirmed that will add to the psycogenic effect.

Some days I still get decent erections, other days it’s pretty bad. I almost always need to adapt positions or rhythm during sex. I'm trying to figure out what other conservative options i can pursue before injections, embolization or even implants in the long term.

Could this have a big part that is psycogenic? Maybe something like welbutrin help?

Anyone who has had a similar Doppler profile—did anything help stabilize or improve function? Can this sort of leak be managed or improved without surgery? Does this condition always get worse? I’d really appreciate hearing what worked (or didn’t) for you.

Thanks a lot.

[ElbowRoom]

I think you have to accept what the numbers are showing you. You have some insufficiencies that are causing your ED, and any psychogenic effects are likely from anxiety caused by lack of performance due to those issues. Pills working less well over time is a classic symptom of progressive ED, and that happened to me and most of the others that are going down the road of alternate therapies.

One thing I can recommend that has helped my is supplementation with amino acids that are nitric oxide precursors. I take 2000mg L-Arginine and 2350mg L-Citrulline daily, and after a couple of weeks of that I noticed much better, strong morning erections. It hasn't helped with my ED otherwise, but then I'm worse off than you are in that department.

Also if you don't have a VED, you should get one and use it. If you're not having normal erections throughout the day, atrophy can start to happen in the tissues that aren't getting stretched, and over time you'll get loss of length and girth. Using a VED daily will exercise those tissues and keep them healthy. You can also use the VED with constriction bands to help the quality of your erections during intercourse.

You are likely starting down the same road as many of us, and if the pills continue to fail you you'll have to make some choices about injection therapy or an implant.

[GoodWood]

Your doppler result show Veno -Occlusive Disorder or venous leak.

You are getting plenty of blood flow in to your penis but it is not getting trapped effectively. Too much blood is flowing out.

This isn’t psychogenic. It’s physiological.

Try the different pills that are available to you.
Try different cock rings. They will help slow the outflow of blood. I tried several and like silicone ones that provided a medium amount of pressure. Lighter pressure ones didn’t work. Tighter ones were uncomfortable.

The prostaglandin shot they gave you for the Doppler had an effect so injections might work out well for you.

If none of that works then it is time to pursue an implant.

[Ahchuykak]

Thanks for the replies guys,

So even going to negative numbers on EDV doesnt matter?

I read that if it is lower than 5 its actually functional and below 0 is desired. Should i consider the observation of the radiologist more important?

I also want to add, i had 0 libido at the time and they gave me a screen to watch 90's porn which felt very awkward.

Could these play a major factor into the results?

[sogwap]

Like most who are a part of this forum. You have ED. Be thankful, there are solutions.

I went through most of the same trauma, Maybe... if only... Pills sort of worked... It wasnt until my wife stopped wanting sex because of my ED that I finally gave Trimix a try.

In most cases, you try things. You tried pills, P-Shot, Stem Cell, and Shockwave. As you said, none of them were (that) effective.
You also have a Doppler, which shows venous leak. If you doubt the results, find another doctor's clinic and get a second opinion.

Please, for the love of your life, dont be like me and skirt around the issue. Trimix can work in some cases with mild venous leak. Or maybe not. The psychological effects of ED are not worth living half your life with a dick that only parially works.

And as one proponent said, Never be ashamed of having ED, or seeking treatment.

I can tell you one thing, Trimix has given me the best erections of my life. And for what it is worth, when I had my Doppler, I asked if I had venous leak or psychological. He wasn't definitive. But my Ed is in part psychological. When I go to have sex, I no longer worry if I can get and keep it up. Now I have to ask my wife if she has had enough. The negative energy that both my wife and I used to have nearly killed our sex life.

To be clear Trimix may or may not work for you, that is not the reason I decided to respond. But I assure you there are solution.