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Author Topic: Why don't urologists do ultrasounds or MRIs ?  (Read 276 times)

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Paul80

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Why don't urologists do ultrasounds or MRIs ?
« on: July 22, 2022, 10:51:18 PM »

Hello, the truth is that I have already spoken with many people who have problems with their penis and it strikes me that many urologists, I believe almost all of them, do not do enough tests on our penises to know what degree of injury we have, where it is located, the measures they have, and what areas are affected. yes, I know that they have a lot of experience but they don't have an ultrasound on their fingers and if the ultrasound doesn't give results, do other tests such as magnetic resonance imaging. I see many comments from many people who are undergoing some kind of treatment but do not really know what they have inside the penis, who do not know if their lesion is in the tunica albuginea or in the corpus cavernosum. and for me it is not the same, for example, to have a Peyronie's plate in the tunic than a nodule in the corpus cavernosum. or have the plaque clacified in the corpus cavernosum or in the tunica. I think from everything I read that we are like in prehistory as far as penises are concerned. And I see how many doctors order traction to people who don't even know where their injury is and what type it is. and it can be harmful to use, for example, restorex on an injury that they don't know exactly which, how or where it is located and that we are not spending a lot of money on doctors who don't even do those tests and others who don't even touch your penis. just for photos? I don't think that someone who breaks a leg doesn't even have an x-ray and a photo of how that leg is is enough to treat it. It does not fit in my head that the majority of people here in the forum do not know where their injuries are exactly and with documentary evidence, what type of injury it is and its size and more characteristics because that would clarify many symptoms, and the doctor only with palpation I can already say, for this there is nothing or use rextores and cialis. I don't think that for the money one spends on these doctors we should demand these tests from them, otherwise how are you going to know which is the best treatment for you? I have asked a lot of people on the forum what their injury is and I am amazed because THEY DON'T KNOW, and they have been doing treatment for years. So friend, and if you are doing traction on a nodule in the corpus cavernosum in the area where the device is picked up, you have been doing it wrong for a long time and hurting yourself and narrowing the area more. If you have an injury to the tunic, they should tell you exactly how many millimeters you have and how many they are and where they are, because otherwise you will never be able to objectively verify if you have made progress or the opposite.

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injury during sex in January 2022. note like a needle stick. result fibrosis nodule 7mm by 5mm oval. dorsal curvature 20 degrees, hourglass narrowing. currently cialis 5mg, pentox 400 once a day, and Ved therapy

Paul80

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Re: Why don't urologists do ultrasounds or MRIs ?
« Reply #1 on: July 22, 2022, 11:07:34 PM »

In conclusion, I think we should demand more from the doctor since we spend a lot of money. And not just so that they touch our penis with their fingers and say yes there is scar tissue. and end? nooo no doctor I want to know where exactly that scar tissue is, how much it measures, what areas it is affecting and which ones it could affect more. Because look, doctor, I have shown you a photo that shows a 30-degree curvature, but you don't know if my erection was 70, 90, or 50 percent. so in the end you don't know almost anything either because of the photography I've shown you. Nor does he know the path traveled to achieve that erection, time and various forms that the penis takes. So I think we should demand more documented evidence of our injuries because just showing photos and feeling with your fingers (if they do, because some doctors don't even do that, just a photo) with that is not valid to make determinations with something that It is not affecting much in our life in all facets and psychological as well. I think we should demand more when we are also spending a lot of money and then in 15 minutes without any proof you go home, which by the way is hundreds of miles away with a silly face. just knowing what you already knew, that you have scar tissue and that you have to buy an extender. I don't know if you understand me. Any opinion or am I going crazy thinking that urologists don't care about us?
Enviar
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injury during sex in January 2022. note like a needle stick. result fibrosis nodule 7mm by 5mm oval. dorsal curvature 20 degrees, hourglass narrowing. currently cialis 5mg, pentox 400 once a day, and Ved therapy

FlatteningTheCurve

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Re: Why don't urologists do ultrasounds or MRIs ?
« Reply #2 on: July 23, 2022, 05:32:40 AM »

I understand your frustration but I am not sure I agree with your statements.

I am not a doctor, but my understanding is that ultrasounds might be a complement to a physical examination, if needed, but it cannot replace it. The questions you want answers to (where the scar tissue is, measurements, areas impacted etc.) require a physical exam as well, which might do a better job at providing clarity than e.g. an ultrasound. Sometimes, depending on your situation and the treatment you are looking for doesn't require an ultrasound or MRI.

For the treatment I am receiving, they did an ultrasound before the treatment started and measured the blood flow etc. and will also do one at the end, but the purpose of this is not to guide the treatment but more as an additional form of evaluation. I think that it is more important that someone who feels multiple plaques each day can do a physical examination and tell me that they have softened considerably.

As Dr Trost said in another post recently:

"Penile ultrasounds are often less 'sensitive' in being able to pick up Peyronie's plaques compared to doing a physical exam.  Because the plaque is often made of similar tissue to the corpora, you can't differentiate where the plaque starts and where normal tissue ends.  So, ultrasounds are really only good for differentiating calcified vs non-calcified plaques in my opinion."

Those are just my two cents!
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Early 30s, diagnosed with Peyronies in 2017 after trauma during sex. ca 15 degrees upward curvature. Restorex, VED, 5mg Cialis, Pentox, L-arginine, Coq10, Propolis, Vitamin E. Underwent 12 rounds of Verapamil injections 2021-22

Bud luck

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Re: Why don't urologists do ultrasounds or MRIs ?
« Reply #3 on: July 23, 2022, 09:53:06 AM »

I agree with Paul, it is very important in my opinion to know where the damaged is located, if is on the Tunica or is is on the corpus cavernosum. I don't understand why Urologists don't take their time to do an MRI and really examine the penis, in my case they only look at my pictures from my phone, except one that did ultrasound just to check on the penis blood flow.
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My first symptoms started early in 2019
I tried Traction device, Pentofixiline, Q10, TRT, L-Argenine, cialis
I have narrowing/dent/hinge on the left side of my shaft
My Erectile Dysfunction is getting worse
Had a PRP shot Aug 2021
I have a girlfriend
Age 46

Paul80

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Re: Why don't urologists do ultrasounds or MRIs ?
« Reply #4 on: July 23, 2022, 02:24:02 PM »

by his words then he is proving me right in some way. I was not talking about one thing replacing the other. I was saying that you should do these tests, and from what I see they have been done to you. I think that in the end you would like to know if there has been any progress through diagnostic tests and not only through the palpation method, and they are going to do it for you. To you then they are doing it correctly and therefore you are giving me the reason. Palpation and diagnostic tests should always be done for all cases. it is my personal opinion
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injury during sex in January 2022. note like a needle stick. result fibrosis nodule 7mm by 5mm oval. dorsal curvature 20 degrees, hourglass narrowing. currently cialis 5mg, pentox 400 once a day, and Ved therapy

FlatteningTheCurve

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Re: Why don't urologists do ultrasounds or MRIs ?
« Reply #5 on: July 23, 2022, 02:59:28 PM »

If byn 'him' you mean me then no, I do not think I am validating what you are saying. Let me clarify:

You are saying that in your personal opinion, doctors should always do both a physical exam and an ultrasound. I am saying that it is up to the specialist to decide what is necessary, given the circumstances, to provide the right kind of treatment or advice. I do not believe they should be doing ultrasounds just because, or to make the patient feel as though they are getting value for money. I am more interested in paying for an expert opinion, not a pre-defined set of examinations.

Again, In myspecific case, the doc did an ultrasound before the treatment but not necessarily to answer the questions you are raising, but rather as a baseline. The exact location of the plaque and specific areas or issues to focus on was decided more by a physical exam as well as a review of what the penis looked liked while erect. Just because they did that for me does not mean that it should be the standard treatment for all patients by all doctors.

To be completely honest, this is the 4th specialist I am seeing and it is the first time that I have had an ultrasound. This is only because it is required for this specific treatment so please do not take it as evidence of what should be done in your case or others'.
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Early 30s, diagnosed with Peyronies in 2017 after trauma during sex. ca 15 degrees upward curvature. Restorex, VED, 5mg Cialis, Pentox, L-arginine, Coq10, Propolis, Vitamin E. Underwent 12 rounds of Verapamil injections 2021-22

Paul80

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Re: Why don't urologists do ultrasounds or MRIs ?
« Reply #6 on: July 23, 2022, 06:04:26 PM »

Good friend, you have your opinion and I have mine. It's not about quality price, I'm not buying in a supermarket, I'm talking about health. and in people's health, the more tests you do, the better. why friend? Look in the first place because the same doctors move by evidence, what is more evident than an ultrasound or an MRI? Do you believe that palpation is as evident as one of these aforementioned diagnostic tests? they are used to feel and of course I do not doubt the professionalism of any of them, I am simply making a constructive comment. first of all if you have a lump on your penis and it is malignant? They know that by palpation? The logical thing would be the first thing to do an ultrasound to see the characteristics of that lump on his penis. Once anything malignant has been ruled out, my opinion is to know where that lesion is, its characteristics and the affected area, and you don't know that by palpation alone, I'll tell you again, your fingers and your experience (the doctors) is a lot, but your hands are not devices digital. And to find out if it's Peyronie's, if it's a trauma, to rule out anything malignant or if it's anything else, they'll have to do imaging tests at the same time they palpate, right? I think I am saying something totally coherent and logical.
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injury during sex in January 2022. note like a needle stick. result fibrosis nodule 7mm by 5mm oval. dorsal curvature 20 degrees, hourglass narrowing. currently cialis 5mg, pentox 400 once a day, and Ved therapy

Paul80

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Re: Why don't urologists do ultrasounds or MRIs ?
« Reply #7 on: July 23, 2022, 08:48:44 PM »

Did you know your injury from the first moment the doctor felt it? did you know it was peyronie? why the curve? by touch? did you know if he also had corporal fibrosis? Did you know if he had plates in the tunica albuginea? under the tunic? did you know the measurements? did you know how many he had? Do you know their evolution over time? they have improved? have gotten worse? why by touch? Do you know if you already had any calcified plaque from the beginning when you went to the first doctor? Do you know if you have any calcified plaque or not in the corpora cavernosa? why by touch? for the photos? please friend what is logic and coherence is logic and coherence and in that aspect of doctors I feel abandoned. once you get into penile injury there is little you can do and that is my impression. I have already been to about 10 urologists and you know what? Only one did an ultrasound and MRI, while for the remaining 9 he was diagnosed with Peyronie's and after the test it turns out that what I have is corporal fibrosis. and I suspect that in this forum from what I see there are many people who still after a lot of years are still treated for Peyronie's, and they don't know anything else because they don't have even a simple imaging test. and surely many of them do not have peyronie's. but it's easier to say it's peyronie: come next patient.
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injury during sex in January 2022. note like a needle stick. result fibrosis nodule 7mm by 5mm oval. dorsal curvature 20 degrees, hourglass narrowing. currently cialis 5mg, pentox 400 once a day, and Ved therapy

nemo

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Re: Why don't urologists do ultrasounds or MRIs ?
« Reply #8 on: July 24, 2022, 06:54:40 AM »

I'm sorry to say, I think the reason these tests are so rarely done is because there is a lack of effective treatments for Peyronies Disease. Thus, your average urologist, having no expertise regarding Peyronies Disease, and having no proven treatments to remedy the condition, has little interest in doing expensive testing that will result in essentially the same diagnosis and advice he/she gives when you first present ... wait, see what happens, if it gets so bad you can't have sex then we'll talk about surgery.

I think an ultrasound or MRI in the hands of anyone other than a Peyronies Disease specialist (of which there are precious few) would simply be a waste of time and money.

nemo
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51 yrs. old, multiple auto-immune conditions. First episode of Peyronies Disease in 2002. Recurred a couple times since. Over the years I have tried Topical Verapamil, Iontophoresis, all the supps and Cialis + Pentoxifylline. Still functional, always worried.

FlatteningTheCurve

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Re: Why don't urologists do ultrasounds or MRIs ?
« Reply #9 on: July 24, 2022, 03:14:01 PM »

please friend what is logic and coherence is logic and coherence and in that aspect of doctors I feel abandoned.

What I take from this is that you feel like you are not being heard and understood, which is totally fine. These situations are not easy and there are many of us who feel like several doctors gave us the most unsatisfactory answer one could get when your penis is not working/looking as we are used to: wait and see.

I think you are raising a few things here, first I thought your initial posts were about value for money. Now, after the other posts, it seems like you are raising concerns about people getting the correct diagnosis. These are very different things.

Ultimately, I have provided some suggestions but also agree with nemo's points. You asked for other opinions and now you have two.

Hope others will chime in with other thoughts and perspectives.
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Early 30s, diagnosed with Peyronies in 2017 after trauma during sex. ca 15 degrees upward curvature. Restorex, VED, 5mg Cialis, Pentox, L-arginine, Coq10, Propolis, Vitamin E. Underwent 12 rounds of Verapamil injections 2021-22

Paul80

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Re: Why don't urologists do ultrasounds or MRIs ?
« Reply #10 on: July 24, 2022, 05:54:05 PM »

I kind of agree with what nemo says. The only thing I don't agree with is that it assumes that everything that happens in the penis is Peyronie's, and everything isn't Peyronie's, that's why I'm amazed that they don't do diagnostic tests. An average urologist may not understand Peyronie's or penile lesions, but I believe that these tests should always be done when there are findings inside the penis.
Regarding what Flatenninthecurve says, the truth is that I don't understand you, because you talk a lot but basically you don't say anything, or at least what I understand (it could be that it is the google translator). friend, it does not matter how I feel, or the intention of what I am proposing is one or the other, the silvering is: palpation and diagnostic tests, and if that urologist does not know at least the next urologist I go to, I will already have my tests done and knowing what I have injured. and there may or may not be treatment, but at least I know what I have in there because it is my penis and it is my health and I am also paying. Just as you believe that I am not being heard or understood, I think that you are defending something
which is logically infeasible. I mean, do you defend that a doctor does not do all the tests that are for your health? I don't know anymore I have to think that we are being watched in this forum and you are trying to look good. It doesn't matter my feelings, it doesn't matter if I have written it with one intention or another, my intention is that all possible tests be done for the health of each one, there is treatment or there is no treatment. but if you don't know exactly what you have, I don't know what medicine that is.
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injury during sex in January 2022. note like a needle stick. result fibrosis nodule 7mm by 5mm oval. dorsal curvature 20 degrees, hourglass narrowing. currently cialis 5mg, pentox 400 once a day, and Ved therapy

Paul80

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Re: Why don't urologists do ultrasounds or MRIs ?
« Reply #11 on: July 24, 2022, 06:28:20 PM »

nemo: you're right those tests in the hands of doctors who are not peyronie's specialists would make no sense. But in the first place everything that happens inside the penis is not Peyronie's and secondly here most people have been to more than two, three and 4 urologists and it would be more logical that from the first urologist that one has been, he already knows perfectly why those tests if you really have peyronie's or not, and the other details that these tests provide. In everything else you said I agree with you.
Flatteningthecurve you have been to 4 urologists right? and it is this fourth urologist who has done the ultrasound because it is necessary for the treatment. Can you imagine going to this fourth urologist and being told that you don't have Peyronie's because of what you see on the ultrasound? You would not think why the first urologist from the first moment did not do this test? By the way, what doctor is treating you now? Could you tell me the name of the doctor? it's out of curiosity.


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injury during sex in January 2022. note like a needle stick. result fibrosis nodule 7mm by 5mm oval. dorsal curvature 20 degrees, hourglass narrowing. currently cialis 5mg, pentox 400 once a day, and Ved therapy

Paul80

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Re: Why don't urologists do ultrasounds or MRIs ?
« Reply #12 on: July 24, 2022, 07:26:21 PM »

Chronic Traumatic Cavernopathy. A New Syndrome of Penile Fibrosis
Introduction The condition called “Peyronie's disease” is a diagnosis that explains a percentage of the states of severe penile fibrosis, but not enough to cover the wide grey range of penile fibrosis secondary to repeated sexual micro-trauma.

Purpose To describe a new syndrome due to repeated trauma to the penis, which is proposed to be called “Chronic traumatic cavernopathy” (CTC), with 4 components: fibrosis, erectile dysfunction, curvature and penile venous leakage.

Materials and Methods A cross-sectional study was conducted on a database of 128 patients who had at least one penis ultrasound performed with a vasoactive, and had some degree of cavernous fibrosis according to Levine classification. An evaluation was made on the presence of erectile dysfunction, curvature, and venous leakage depending on the degree of fibrosis. The study was approved by the Research Ethics Committee.

Results The study included 128 patients with penile fibrosis, and a mean age of 52.9 years (SD = 13). The degree of fibrosis was mild (Levine 1) in 30 (23.43%), moderate (Levine 2) in 23 (17.96%), and severe (Levine 3) in 75 (58.6%). It was shown that the higher the fibrosis, the more erectile dysfunction (Erectile Dysfunction), with 66.6%, 83.6%, and 96% for Levine 1, 2, and 3 respectively (P ≤ 0.0001). Frequency of secondary curvature (n = 71) was 0%, 4.2%, and 95.7% for Levine 1, 2, and 3, respectively (P ≤ 0.0001). The frequency in 44 cavernous patients with venous leakages was 9%, 20.4%, and 70.4% (P = 0.0060), and with 15 dorsal leakages it was 80%, 13.3%, and 6.6% (P < 0.0001) for Levine 1, 2, and 3, respectively. The group of 79 (64.03%) patients with increased possibility of CTC, and who met the 4 criteria, or the 3 criteria including secondary curvature and cavernous venous leakage, had a mean age of 59.2 years (SD = 8.7), compared to 41.7 years (SD = 11.7) in the other group with less possibility, which had a statistically significant difference (P ≤ 0.0001).

Conclusions We propose that there is a syndrome of repeated micro-trauma in penis, which can be called CTC, analogous to chronic traumatic encephalopathy, with 4 components: cavernous fibrosis, erectile dysfunction, penile curvature, and venous leak. Fibrosis is a continuum that, in the patient goes through mild and moderate stages, and often goes unnoticed by clinicians. Secondary curvatures and cavernous leaks are directly related to the degree of fibrosis and increased risk of erectile dysfunction. Age aggravates some factors of CTC.
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injury during sex in January 2022. note like a needle stick. result fibrosis nodule 7mm by 5mm oval. dorsal curvature 20 degrees, hourglass narrowing. currently cialis 5mg, pentox 400 once a day, and Ved therapy

FlatteningTheCurve

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Re: Why don't urologists do ultrasounds or MRIs ?
« Reply #13 on: July 25, 2022, 09:10:04 AM »

I mean, do you defend that a doctor does not do all the tests that are for your health? I don't know anymore I have to think that we are being watched in this forum and you are trying to look good. It doesn't matter my feelings, it doesn't matter if I have written it with one intention or another, my intention is that all possible tests be done for the health of each one, there is treatment or there is no treatment. but if you don't know exactly what you have, I don't know what medicine that is.

Like I said, I am expecting a Peyronies specialist to use his/her expertise to give me the best possible advice and treatment. If that involves ultrasound, then that is fine. If that can be based on my medical history, photos and a physical exam, that is also fine. It seems like what you believe that ultrasounds/MRIs are prerequisites for doctors doing everything they can for my health. I disagree with that and I have told you why.

I am not defending anyone or anything. I am just trying to give balanced and nuanced responses to your different posts, it is not about how I want to be perceived by others on this forum. If I am not getting through to you then that is a shame. Feel free to send me a PM and I will try to answer your questions there if helpful.

Regarding my treatment I am seeing Mr Yap at London Andrology, I recommend him.
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Early 30s, diagnosed with Peyronies in 2017 after trauma during sex. ca 15 degrees upward curvature. Restorex, VED, 5mg Cialis, Pentox, L-arginine, Coq10, Propolis, Vitamin E. Underwent 12 rounds of Verapamil injections 2021-22
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