Priapism with Pentoxifylline and Cialis?

[Federer1981]

Hi, I am a 28-year-old based in the UK under urology for some intermittent psychological Erectile Dysfunction and firmness/narrowing at penile base. Generally however, my erectile function has been good and I could generate full erections alone or with a partner on demand allowing multiple episodes of sexual activity within 24 hours. My question is, has anyone experienced priapism (prolonged, unwanted erection) whilst taking pentoxifylline 400mg three times a day and cialis 5mg once a day?

I was on this regimen from my urologist, and started to wake up at night/in the morning with very rigid, full-size erections that would tend to persist if I remained lying in bed. Once I got up and either went to the toilet or stood up for a few minutes, the erection would subside over the course of maximum 5 minutes back to flaccid state. I never experienced any obvious pain and never required medical intervention to return the erections to flaccid. This happened about 10 times over the course of about a month and a half. Unfortunately, I have no idea as to the duration of these episodes as I was asleep prior to waking (therefore I worry the erections could have been persisting for a while in my sleep and causing potential damage from ischaemic/low-flow priapism).

Since these episodes, I have subsequently lost essentially all erectile function. With a lot of work, I can generate something resembling an erection when I am alone, but it is by no means a 100% erection. Furthermore, I need to be sat down and if I stop stimulation it will fade away quickly. My flaccid penis feels less 'elastic' and just not as I remember it. Furthermore, I have no nocturnal or morning erections anymore and this has been the case for about a month and a half.

Has anyone else on the pentoxifylline + PDE5i (viagra or cialis once daily) combination had a similar problem and, if so, has there been any improvement?
Furthermore, does the description of the overnight episodes seem to fit with low-flow/ischaemic priapism, or would there typically be pain and more difficulty in relieving the erection once waking?
I am awaiting results of a penile MRI and USS (both done without injection in flaccid state due to worry over priapism from Consultant) but the initial informal feedback suggests they have seen nothing overtly abnormal.

Thanks and I hope someone will be able to shed some light on my situation!

[Juan]

As far as I know, priapism does not subside by itself. Medical care is necessary.

In my case, I started cialis a month before pentox and since the first day on cialis I experienced nocturnal erections. So based in my expierence, I'd say pentox has nothing to do with the NTE.

On the other hand, like you, I don't know how much are lasting my NTE as I'm sleept. I usually go bed at midnight and aroung 4 am I wake up erected, go to pee, and erection quickly subsides.
I suppose I'm having just one long lasting erection rather than many short lasting erections. Is this normal? Is this good?

It's widely said in the forum that NTE are good for recovery and a healthy penis sign. However I'd like to know more abut this. What is the good thing about the NTE? blood flow? penis erected is stretching the plaque?

A doubt, when a penis is erected, the blood in the penis is continuosly flowing in and out? or the flow is static?
If it would be continuously flowing, why priapism would have the risk of isquemia? blood would be oxigenated all time...

[Federer1981]

Hey Juan, thanks for your reply! Ok, that is similar to what I have read in that a 'major' or 'fulminant' ischaemic priapism normally will not subside after waking and medical treatment will be required to bring it down. Furthermore, most studies that cite priapism starting overnight/in the morning will be giving the duration of priapism in hours from the point at which the patient woke (clearly they can't do anything else as it would all be guesswork to try and predict duration during sleep). Therefore, if we are taking our experience, it would only be lasting several minutes by 'study' standards.

So since you have been on the cialis and the pentox, your erection experience hasn't really changed or become more prominent? That is what I thought anyway, that pentoxifylline didn't do much in the way of adding to erectile function but rather was for anti-fibrotic effect! Nevertheless, I am worried as my erectile function has been really bad since these overnight episodes when I was on the combination of the drugs - it didn't happen whilst on the cialis alone (I know this doesn't prove the pentoxifylline contributed and it could all be coincidental).

I guess as long as you are not being woken up by pain and the erection subsides within a few minutes once getting up, that suggests there is no problem occurring. Would your erection normally subside within a few minutes once you're up? Also, are you getting these long NTEs most nights/every night since starting cialis?

I do believe that NTEs are very important for maintaining penile tissue health and elasticity, and clearly having no NTEs will be likely detrimental in the long term. Nevertheless, if able to gain erections during the daytime, I think this can offset a lack of NTEs. Like you say, I think the function of NTEs is both to increase oxygen tension in the penile tissues (oxygenation) as the oxygen tension in a flaccid penis is very poor, and also to stretch the tissues (corpora/tunica etc.) to keep them elastic and pliable.

In terms of the question of erection, I believe if a penis is fully erect, there should not really be any flow out or in, as it is a closed circuit. If there were flow out, this would make it hard to maintain an erection and essentially reflect some degree of venous leak. That is the problem with low-flow priapism - a compartment syndrome essentially happens where no fresh blood is entering the penis and therefore over a period of hours, ischaemia eventually develops leading to tissue damage. However, it isn't exactly clear at what point this occurs but it seems that under 12 hours almost no one experiences any permanent changes. Even from 12-36 hours there is no consensus in the literature on resultant damage, but the chances of damage go up with duration and it is difficult to predict who will end up with some dysfunction and who will recover back to baseline. Reassuringly, there are studies in which patients have suffered long priapisms (>14-16h) requiring shunts with resultant ED, but have recovered good erectile function over a period of months to a year. Why this happens I don't know but potentially some tissue remodelling takes place with time.

[Juan]

Federer,
How are you doing with the nte? Did you recover/improve your erectile function?
Did you reach any conclusion if those nte episodes were actually a sort of priapism?

I'm very worried because two nights ago I had a nte episode like the ones we are talking about.
Went bed at midnight. I woke up to pee at 3 with a very hard erection (not very painful but discomfort). Went to the toiled, wait couple minutes until the erection subsided enough to point down to the toilet, pee and went back to bed almost erected. In the morning I woke up at 7 again with a hard erection with discomfort.
Rest of the day I had a very bad hard flaccid and a numbness sensation and itchy feeling. This symptoms still continue today.

Since I'm with cialis I'm having similar nte episodes but those never led me with these hard flaccid and itchy symptoms like now.

I'm really worry if what I experienced could have been a kind of priapism.