Met Dr Ralph / The Merits of Ultrasound

[defiant]

Hi all,

An update from me on my situation and a couple of thoughts on doppler ultrasound as a definitive means of ED diagnosis.

Many of you will know my history. But for those that don't, in a sentence, I'm 34 and since the age of 21/21 I've noticed a decline in my erections, become dependent upon Cialis, had 3 ultrasounds with 3 separate centres across many years and have two differing diagnoses, one saying mild venous leak, two saying no leak, just a bad case of performance anxiety.

That's it in a nutshell.

I have taken huge issue with the way in which ED or the lack thereof is diagnosed via doppler ultrasound. It doesn't seem to be standardised across healthcare, universally and appears to be susceptible to misdiagnoses.Take me for example; 3 scans, 1 with a leak, 2 without. So why might this happen? Also, the way in which the test is performed appears to vary wildly from centre to centre; touch yourself, don't touch yourself, wait 10 minutes, wait 1 minute and so on and so forth.

I have been plagued by this doubt for years now and it is only today that I took action and saw the esteemed Dr David Ralph in London, a world-class implant specialist andrologist.

I found him to be a 'down-to-business', pragmatic and no-nonsene kind of guy, interested only in facts and getting to the route of the problem. It was my shortest urological meeting but perhaps the most promising.

The impression I got from him was that he believes ultrasound is just not enough to categorically diagnose or indeed rule out physical problems that cause ED. Therefore he has ordered NPT for me, nocturnal testing and potentially cavernosography which is a more invasive yet detailed diagnostic testing process for ED.

What made me the most comfortable was his final thought; that indeed all of this could very well be psychogenic but he sadly does see many young men appear in his office, all frustrated, all wanting a normal life, they've tried it all, the injections, the pills and it just doesn't do it for them - they get an implant and then 'we never see them again' - said in a way that suggests the patients are healed of ED and just leave this hell behind them and get on with life. And that gives me HOPE. But at the same time makes me sad that even psychogenic ED can be as crippling as physical causes.

He did say, that if it gets to that point, come to him and get it done on the National Health Service which was music to my ears. I wouldn't have to pay for it. And I would be in the hands of a world-class surgeon.

I will go through with this testing, resolved to get to the bottom of this PLIGHT! This HELL. If it really is psychogenic, I'll try to work with someone I love, along with some psychiatry and time. If that fails, I will get implanted.

But, If any physical deficiencies are found, show me the consent form, Mr Ralph!

From a hopeful DEFIANT.

Goodnight, my brothers. My prayers are with you all.

[ThePlumber1964]

Great news for you, defiant!!!

[defiant]

Great news for you, defiant!!!

Thank you, it is a positive move.

I really wanted to post an update of my own and this message because I believe some people and indeed some doctors more worryingly make such life-changing decisions based on a disputable test.

Also, people here really need to understand the power of the mind and how intrinsically linked with the mind the arousal process is. Something I will write on at a later date!

[Spikepork]

Amen to that!!

[star_of_pramen]

Congrats, sounds like you're on the right path. Hope the NHS waiting list isn't too long!

[BionicLeeroy]

Hi Defiant, If you do proceed with an implant on the NHS, hopefully you will get DR Ralph actually performing the surgery. There is no guarantee of this. Dr Ralph was also my lead consultant when I had an implant. However on the day he did not carry out the procedure. It was one of his colleagues. If your having this done at UCLH this is a teaching hospital and he might just be overseeing the operation.

[Larry10625]

Hi Defiant, If you do proceed with an implant on the NHS, hopefully you will get DR Ralph actually performing the surgery. There is no guarantee of this. Dr Ralph was also my lead consultant when I had an implant. However on the day he did not carry out the procedure. It was one of his colleagues. If your having this done at UCLH this is a teaching hospital and he might just be overseeing the operation.

IMHO, that's the same thing... AND, they reconstitute more surgical geniuses.

Larry

[Larry10625]

Hi all,

An update from me on my situation and a couple of thoughts on doppler ultrasound as a definitive means of ED diagnosis.

Many of you will know my history. But for those that don't, in a sentence, I'm 34 and since the age of 21/21 I've noticed a decline in my erections, become dependent upon Cialis, had 3 ultrasounds with 3 separate centres across many years and have two differing diagnoses, one saying mild venous leak, two saying no leak, just a bad case of performance anxiety.

That's it in a nutshell.

I have taken huge issue with the way in which ED or the lack thereof is diagnosed via doppler ultrasound. It doesn't seem to be standardised across healthcare, universally and appears to be susceptible to misdiagnoses.Take me for example; 3 scans, 1 with a leak, 2 without. So why might this happen? Also, the way in which the test is performed appears to vary wildly from centre to centre; touch yourself, don't touch yourself, wait 10 minutes, wait 1 minute and so on and so forth.

I have been plagued by this doubt for years now and it is only today that I took action and saw the esteemed Dr David Ralph in London, a world-class implant specialist andrologist.

I found him to be a 'down-to-business', pragmatic and no-nonsene kind of guy, interested only in facts and getting to the route of the problem. It was my shortest urological meeting but perhaps the most promising.

The impression I got from him was that he believes ultrasound is just not enough to categorically diagnose or indeed rule out physical problems that cause ED. Therefore he has ordered NPT for me, nocturnal testing and potentially cavernosography which is a more invasive yet detailed diagnostic testing process for ED.

What made me the most comfortable was his final thought; that indeed all of this could very well be psychogenic but he sadly does see many young men appear in his office, all frustrated, all wanting a normal life, they've tried it all, the injections, the pills and it just doesn't do it for them - they get an implant and then 'we never see them again' - said in a way that suggests the patients are healed of ED and just leave this hell behind them and get on with life. And that gives me HOPE. But at the same time makes me sad that even psychogenic ED can be as crippling as physical causes.

He did say, that if it gets to that point, come to him and get it done on the National Health Service which was music to my ears. I wouldn't have to pay for it. And I would be in the hands of a world-class surgeon.

I will go through with this testing, resolved to get to the bottom of this PLIGHT! This HELL. If it really is psychogenic, I'll try to work with someone I love, along with some psychiatry and time. If that fails, I will get implanted.

But, If any physical deficiencies are found, show me the consent form, Mr Ralph!

From a hopeful DEFIANT.

Goodnight, my brothers. My prayers are with you all.

Ya know, the more I think of it, the more I believe that be it physical or psycogenic, the implant may just be the cure for both. With the physical side of things, it's obvious but with the psychological, the implant gives you confidence because you can get a woody whenever, wherever and for as long as you like. This confidence goes a long way towards curing the psychological issues. Just my opinion.

Larry

[defiant]

Hi all,

An update from me on my situation and a couple of thoughts on doppler ultrasound as a definitive means of ED diagnosis.

Many of you will know my history. But for those that don't, in a sentence, I'm 34 and since the age of 21/21 I've noticed a decline in my erections, become dependent upon Cialis, had 3 ultrasounds with 3 separate centres across many years and have two differing diagnoses, one saying mild venous leak, two saying no leak, just a bad case of performance anxiety.

That's it in a nutshell.

I have taken huge issue with the way in which ED or the lack thereof is diagnosed via doppler ultrasound. It doesn't seem to be standardised across healthcare, universally and appears to be susceptible to misdiagnoses.Take me for example; 3 scans, 1 with a leak, 2 without. So why might this happen? Also, the way in which the test is performed appears to vary wildly from centre to centre; touch yourself, don't touch yourself, wait 10 minutes, wait 1 minute and so on and so forth.

I have been plagued by this doubt for years now and it is only today that I took action and saw the esteemed Dr David Ralph in London, a world-class implant specialist andrologist.

I found him to be a 'down-to-business', pragmatic and no-nonsene kind of guy, interested only in facts and getting to the route of the problem. It was my shortest urological meeting but perhaps the most promising.

The impression I got from him was that he believes ultrasound is just not enough to categorically diagnose or indeed rule out physical problems that cause ED. Therefore he has ordered NPT for me, nocturnal testing and potentially cavernosography which is a more invasive yet detailed diagnostic testing process for ED.

What made me the most comfortable was his final thought; that indeed all of this could very well be psychogenic but he sadly does see many young men appear in his office, all frustrated, all wanting a normal life, they've tried it all, the injections, the pills and it just doesn't do it for them - they get an implant and then 'we never see them again' - said in a way that suggests the patients are healed of ED and just leave this hell behind them and get on with life. And that gives me HOPE. But at the same time makes me sad that even psychogenic ED can be as crippling as physical causes.

He did say, that if it gets to that point, come to him and get it done on the National Health Service which was music to my ears. I wouldn't have to pay for it. And I would be in the hands of a world-class surgeon.

I will go through with this testing, resolved to get to the bottom of this PLIGHT! This HELL. If it really is psychogenic, I'll try to work with someone I love, along with some psychiatry and time. If that fails, I will get implanted.

But, If any physical deficiencies are found, show me the consent form, Mr Ralph!

From a hopeful DEFIANT.

Goodnight, my brothers. My prayers are with you all.

Ya know, the more I think of it, the more I believe that be it physical or psycogenic, the implant may just be the cure for both. With the physical side of things, it's obvious but with the psychological, the implant gives you confidence because you can get a woody whenever, wherever and for as long as you like. This confidence goes a long way towards curing the psychological issues. Just my opinion.

Larry

The doctor was quite frank indeed. Sometimes even in purely psychogenic cases men end up with implants and after that, their problems are largely behind them and they can be free of the mental woes of this curse.

[defiant]

Hi Defiant, If you do proceed with an implant on the NHS, hopefully you will get DR Ralph actually performing the surgery. There is no guarantee of this. Dr Ralph was also my lead consultant when I had an implant. However on the day he did not carry out the procedure. It was one of his colleagues. If your having this done at UCLH this is a teaching hospital and he might just be overseeing the operation.

If I did go down that route, I would find out as soon as possible if Dr Ralph would be the lead surgeon and only give me expressed consent for him and him alone to perform. He did say ‘make sure you come to me’ so that was good. I hope he doesn’t retire any time soon!