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Author Topic: Afraid Of Alprostadil (Caverject) Injection For Ultrasound Test - Opinions?  (Read 7202 times)

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Kulak

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I’m 53.  Two months ago I suddenly developed a downward bend when erect.  A week ago I went to see Dr. Brett Mellinger in Garden City Long Island in New York.  His specialties are male infertility, erectile dysfunction, Peyronie's disease, ejaculatory disorders, and male hypogonadism.

After a manual examination he said he was almost 100% sure that I did have plaque.  I’m scheduled for an appointment with Mellinger in a week to have him perform an ultrasound blood flow test.  The purpose would be to verify that I do in fact have plaque, to get a better look at the plaque if I do have it, and for other reasons involving blood flow that he clearly didn’t have the time or the interest to be particularly specific about.  He’ll perform this test by first injecting Alprostadil into the base of my penis to induce an erection.  I have read the “Ultrasound/Doppler to Confirm Peyronie’s” thread on this board and I can’t say that I found a consensus one way or the other on whether this test can be performed flaccid instead of erect, or if the one time injection of Alprostadil poses much if any danger to someone who likely has Peyronie’s.  The thread did not alleviate any of my concerns.  And “concerns” is putting it lightly.

Any thoughts on my extreme worries about this Alprostadil injection (listed below) would be greatly appreciated:

1.  Like others, I’m afraid of the injection causing an injury that could result in the development of a plaque at the injection site -- particularly if I currently have plaque and likely have a higher propensity for developing them in the first place.

2.  I don’t have Erectile Dysfunction.  I don’t like the idea of being given an “entirely” chemically induced erection.  I’m concerned that undergoing this unnatural erection process could cause a problem with normal erectile function to some degree afterwards.  Either long-term or permanently.  This may be completely baseless, but I don’t know.

3.  My erections cause sharp pains at the urethral opening and on the underside of the head.  But even without that I’d still be afraid of having a full erection that could last an entire hour or even more.  I don’t know what kind of long-term damage that could potentially cause.  Again, this could also be a completely baseless concern.  But I don’t know.

4.  And on top of this there’s always the potential for an allergic reaction, or any of the rare reactions listed with this and most medications.

Thanks
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LWillisjr

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Kulak,
I don't know about your doctor but others generally do the ultrasound while flaccid, and then again once an erection is induced. I believe it is important to have it while erect in order to get meaningful blood flow measurements.

None of us want to have needles poked in our penis, but I believe the risk is minimal to induce an erection for this purpose. I've had the ultrasound test before, and had a series of Verapamil injections and didn't sustain any side effects from any of the injections.

One thing to consider is your degree of curvature. If it is minimal and doesn't keep you from enjoying sex..... then I would suggest reading up on traction and VED therapy posted here and try one of these to correct your curvature. Of course is your curvature is worse than this, then you will need to pursue more aggressive therapies. The ultrasound should reveal if you do have Peyronies Disease and the size and severity of your scarring.

Les
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Skjaldborg

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I went to Dr. Lue to get an ultrasound and he does it without inducing erection (i.e. flaccid). Doppler ultrasounds with induced erection are usually only done on folks with Erectile Dysfunction since it can spot venous leakage, a common cause of Erectile Dysfunction. A flaccid ultrasound is just fine for spotting Peyronie's plaques. If you don't want anything injected by all means refuse; it's your body.

I don't like the part where you mention he didn't go into detail about the procedure. I hate it when doctors do this and sometimes they have to be reminded that YOU call the shots when it comes to elective procedures. If I have a gunshot wound, then yes I'll clam up and let the doctor work. Needles in my already damaged penis? Nope. Not gonna happen.

I suggest asking the doctor to just do a standard flaccid ultrasound. If not, find another doctor.

Best,

Skjaldborg
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james1947

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I agree with Skjaldborg on all his statements!

The ultrasound in flaccid state can show the plaque, ultrasound with induced erection is to test venous leakages.

Also the doctor should explain you very clear what and why on any procedure.
You are the customer and paying for the doctor (or your insurance) and should be treated accordingly!

James
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Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe Erectile Dysfunction.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
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LWillisjr

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I went to Dr. Lue to get an ultrasound and he does it without inducing erection (i.e. flaccid). Doppler ultrasounds with induced erection are usually only done on folks with Erectile Dysfunction since it can spot venous leakage, a common cause of Erectile Dysfunction. A flaccid ultrasound is just fine for spotting Peyronie's plaques. If you don't want anything injected by all means refuse; it's your body.

I don't believe there is a "standard". Some doctors do it and some don't. Dr. Levine's "standard" is to do the test both flaccid and erect and it has nothing to do with whether you have Erectile Dysfunction or not. He wants to know what the pressure and flow rate is into your erection and to see how much if any the scarring or plaque is stretching between flaccid and erect states.

Les
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james1947

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The question is why the specific doctor want to check while erected state. He should give an explanation to the patient and as I understand Kulak didn't get any explanation for what he suppose to make the ultrasound in erect state.

Also if the injection is not of concern, why we, Peyronies sufferers are not using Trimix or other injections to overcome Erectile Dysfunction problems?
Just thinking. If I was having a good solution for Erectile Dysfunction, including injections, surgery of incision and grafting was satisfactory and not thinking about implant with all the possible complications and being an "one way ticket".

Sorry if I sound like "devil advocate" against injections, I am just scared of having some additional plaque to the many I was blessed with.

James
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Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe Erectile Dysfunction.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

LWillisjr

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The question is why the specific doctor want to check while erected state.
James

He wants to know what the pressure and flow rate is into your erection and to see how much if any the scarring or plaque is stretching between flaccid and erect states. I don't believe doctors would do this if there was no purpose or aid to your diagnosis.

He should give an explanation to the patient and as I understand Kulak didn't get any explanation for what he suppose to make the ultrasound in erect state.

I didn't get to talk to the doctor first. The ultrasound was scheduled and performed by a lab in the morning, and I first met with the doctor in the afternoon.


Also if the injection is not of concern, why we, Peyronies sufferers are not using Trimix or other injections to overcome Erectile Dysfunction problems?

Because we now have drugs like Viagra and Cialis. Before these many men did use Trimix to achieve an erection as this was their only option. They still use Trimix in the office to create an erection because it works within minutes and works different than Viagra in that it "forces" and erection. Trimix works differently than Viagra. If I had Erectile Dysfunction, and Viagra or Cialis didn't work for me, I would consider trying Trimix to see if it helped. I'm not saying it doesn't have risks, but it is something to consider. Everyone has to make their own choices.


Sorry if I sound like "devil advocate" against injections, I am just scared of having some additional plaque to the many I was blessed with.
James

I know there are men on this forum that developed issue from injections. So there is a risk. But I know hundreds of men have had injections (Both VIs and Trimix) and didn't have any issues. Also.... there are many men putting faith in the fact that Xiaflex will help them. And guess how it is applied..........??

I've had a total of 24 needle sticks in my penis. They aren't pleasant and I don't care for them. But I was willing to do or try whatever required to correct my condition. The best thing we can do is stay stay focused on the facts and then everyone can make their own informed decisions of what is best for them.

Les

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james1947

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Thanks for the explanations lwillisjr.

I suppose I will get an injection to test the things in erected state before I will proceed with surgery.

Regarding Trimix and other Erectile Dysfunction injections I read on other forums that people are using them if the Viagra, Cialis etc' begin not to help or help not enough. And this is my situation now.
Even that with 3 & 1/2 years in this Peyronies ordeal it seems stable for the last year, I am very scared that any injection will begin new scars as it happened to others on this forum and will complicate the surgery I am planning even more.

Just one more thing. I had too many unpleasant encounters with incompetent doctors , not just in the Peyronies subject (one of them almost killed me with medication he had given to me), this is the reason I am checking very carefully everything that they are saying or want to do. Others may have different experience with doctors and different approaches to them.

James
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Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe Erectile Dysfunction.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

cbijk

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I'm in the same boat with this. I've been scheduled to have a Doppler ultrasound with an induced erection to test mainly soft glans along with any potential plaque associated with Peyronie's. I've been in two minds about getting it done as a I feel anything as invasive as injecting the penis should only be done as last resort!
The thing is I am able to achieve an erection so I don't see why I have to get a forced one. Surely the erection from injection is going to be different from a natural one so how valid are the results? I don't know, just thinking aloud here...
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LWillisjr

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I'm in the same boat with this. I've been scheduled to have a Doppler ultrasound with an induced erection to test mainly soft glans along with any potential plaque associated with Peyronie's. I've been in two minds about getting it done as a I feel anything as invasive as injecting the penis should only be done as last resort!
The thing is I am able to achieve an erection so I don't see why I have to get a forced one. Surely the erection from injection is going to be different from a natural one so how valid are the results? I don't know, just thinking aloud here...

I've had this done and was also able to achieve erections on my own. But you have to maintain the erection for about 10 minutes to complete the ultrasound. And I don't know that I could have "kept it up" with other people in the room. The whole thing is a clinical setting and not very "stimulating". The needle for the injection is very small and is given in the side of the penis about mid shaft. This is to make sure you absolutely avoid the nerve bundle that runs along the top of the penis shaft from root to tip. The induced erection is very much like the real thing.

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shadow

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Quote
And I don't know that I could have "kept it up" with other people in the room. The whole thing is a clinical setting and not very "stimulating".

I'll second that!!  In addition to the PA that was there to direct the ultrasound...there was a female assistant.  :-\

I was provided my choice of porn dvd and headsets and "virtual reality" type goggles in order to produce an erection.  The PA said he was ready to administer an injection if required.  I told him:  You'll probably be doing that.

Sure enough....I was unable to achieve an erection, and even with a reduced dose (because I do not have E.D.)...it took awhile to get where I needed to be.  As if the whole ordeal wasn't bad enough....I couldn't "perform".  ::)

The erection felt pretty much like a natural one...near as I could tell.  I was trying mightily to "divorce" myself from the whole event (thank God for the goggles and headset!!).  The PA said, afterwards, that I had achieved at least a 90% B.R.E. (bedroom ready erection.....his phraseology, not mine). 

I girded myself for the injection.  It wasn't all that bad....but certainly not a feeling I'd ever felt before.

I'm slowly beginning to realize that this disease is plowing new ground for me.  I'm finding myself in situations and doing things (V.E.D. therapy) that I never would have thought was remotely possible before this. 

-Shadow

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cbijk

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Re: Afraid Of Aprostadil Injection For Ultrasound Test - Opinions?
« Reply #11 on: August 20, 2012, 06:30:46 PM »

So no issues relating to having the injection in the weeks after?
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james1947

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cbijk

Personally I am against any injections to my penis because my concern of developing a new scar.
From the other side, for some tests have no other choice than injection, so I will do it.
Regarding your question:
Quote
So no issues relating to having the injection in the weeks after?
I will be a mistake to give you insurance that everything will be fine but in most of the cases will have no problems.

James
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Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe Erectile Dysfunction.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

shadow

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So no issues relating to having the injection in the weeks after?

Can only speak for myself....but no.  Several weeks on an no ill effects.

Quote
Personally I am against any injections to my penis because my concern of developing a new scar.

There is something to be said for this. 

I thought long and hard about whether to do it -- for the reason above and for my own anxiety with regard to the whole ordeal.   Seriously…the worst part was dealing with getting an erection in the presence of people I had met for the first time only minutes before.!!  But…I’m very much introverted and exceedingly private.

However, my motivation was twofold:  To get a baseline diagnosis of blood flow (mine was such that there is no indication of E.D.)  and plaque measurements.  Getting a baseline suggests I'm willing to do it again.  I would anticipate that happening again quite a ways into the future (hopefully very much into the future).  I am hoping to stunt the progression of this disease.  And while the various therapies (VED, Pentox, etc) may slow or even apparently stop the progression of the hourglassing and curvature, I could never be absolutely sure of it without some empirical evidence (I wouldn't trust simple palpation or my own visual assessment to make that call).  I suppose if I saw some genuine reversal of the deformity...I'd be convinced!

I think the experience and bedside manner of the person doing the injection has a lot to do with the pain of the injection and the possible post-injection damage done.

It's a personal decision with many pros and cons.  This disease has a tendency of requiring us to make decisions that would have been completely foreign to us previously.   I’ve been blessed with relatively few significant medical issues in my 50 years.  This one may be the most significant thus far…at least with respect to the decision I have to make to deal with it.

Best to you.

-S
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james1947

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shadow

Everything you have written is correct, except that quoting just one of my sentences it takes it out of content.
What I have written is:
Quote
Personally I am against any injections to my penis because my concern of developing a new scar.
From the other side, for some tests have no other choice than injection, so I will do it.
and not just:
Quote
Personally I am against any injections to my penis because my concern of developing a new scar.

James
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Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe Erectile Dysfunction.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

shadow

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Quote
except that quoting just one of my sentences it takes it out of content.

Hmmm -- well oddly enough my point was to reinforce the part of your statement I quoted --->

Quote
There is something to be said for this. 

I thought long and hard about whether to do it -- for the reason above

......not to dismiss it (which is why I didn’t include the second half -- plus the question was with respect to an ultrasound procedure, the only penile injection scenario about which I can speak about with authority, not other procedures).


As I suggested....to each his own.  Far be it from me to steer someone in a direction with which they are uncomfortable or away from something that could be beneficial.  This is far too personal an affliction for that. 

Apologies.

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james1947

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shadow

I suppose my post was a result of my excessive sensitivity to precision that is a part of my profession.
So accept my apology for the over reaction.

James
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Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe Erectile Dysfunction.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

DO

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Hey there I have had two injections for two ultra sounds in the  past, I have another one scheduled next month. I look at it this way I have a disease ...it needs to be fixed. a professional Urologist handles many penis all day long. What make mine so different then any other man it that it is broken and I want it fixed! Do what you have to, but make it better! No injection caused my peyronies. Now after 12 series of injections of Verapamil over the last 7 months It looks good! Not perfect but way better! Yes it is unbelievable this had to happen to me! Yes never would I believe I let some doc inject me, but I did! I make my own jokes about it, I talk about it ...It is part of who I have become. I wish I could show before and after pictures, maybe it would help. But if the ultra sound helps in some way, even if to prove the progress of Verapamil shots did make a difference for my doctors sake...for him to show positive data to keep insurance to pay for therapy.... I am getting it done. After next month I will miss my urologist (really a great man) but will be very happy not to see him as long as it stays unbroken...
I am grateful because initially he said it was the worse type of bend (downward by 55%). He wanted surgery only after we attempted the shots. I think he is as happy as I am that I did not have take that path!
Good luck to you!
DO (Dan)
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LWillisjr

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DO,
We have only a few accounts of people who had success with VI injections. So appreciate you sharing this, it is interesting to know that the VIs helped you.
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