Penile elastography

General Discussion
#1

After several years of going through all kind of medical tests, I found the test I needed. It’s called penile elastography.
I had the typical PFS (depression, anxiety, erectile dysfunction). The doppler ultrasound showed a venous leak. So there was clearly a problem, but nobody was able to detect the physical cause, since the penile MRI was apparently normal.
A couple of months ago, an urologist suggested that I go through a penile elastography test, which is non invasive and is used to detect possible fibrosis in the flaccid penis.
Finally I found the cause of my physical problems: there is fibrosis in the septum of the penis, usually undetectable on palpation and even in doppler ultrasound/MRI (because these tests measure everything in erection, so the tissues are stretched).

So the hypothesis is this:

  • Finasteride may have weakened the penile tissues
  • Small trauma (masturbation, sex) may have injured the tissues and produced fibrosis in places that are not easy to detect
  • Blood flow in the penis gets impaired

All this is apart from the potential neurological effects.
So if you are facing physical issues (erectile dysfunction, hourglass effect in pre-erect state, etc.), don’t waste time and go for a penile elastography test.

Please share your results. I am pretty sure that most of us have this problem.

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#2

That sounds positive I will try and get this test in the UK

Given those findings where do you go now in terms of treatment?

Thanks

#3

So the theory is that a fibrosis that cant be even detected in MRI and Sonography is causing genital numbness, and zero Libido??

#4

Maybe shockwave will help. It has been shown to improve fibrosis

#5

Exactly, shockwave may help. Also PRP (the good thing is that now at least I know where exactly the PRP injections should go). I will start with those treatments.

#6

Indeed the fibrosis was not detected in MRI and Sonography.
But it was detected by Elastography.
As for numbness and loss of libido, they are correlated with the fibrosis (apparently there is a neurological effect involved: my hormones are ok, but the brain is not findind the local small nerves and local tissue sensation in the penis it used to have pre-Fin, so the signal gets broken and this produces a vicious circle of anxiety, depression, lower libido, etc. This is one hypothesis at least for my case).

#7

Of course, I am not implying that the cause of everything is fibrosis, but it plays a big role here. Actually I decided that as I am not a scientist I won’t spend time trying to find the universal cause of PFS. I am only a patient and need to get a clear picture of where I am right now.
Finding out that I have septal fibrosis was absolutely key for me. When you take Fin, many tissues (specially penis) may lose the reaction to androgens. And what you get at that moment is fibrosis. When you stop Fin, the reaction to androgens usually comes back, but fibrosis remains if you don’t take action.
So now my main problem is local fibrosis (I can even see it in the hourglass effect in pre-erections: the proximal part of the penis has a normal blood flow, but something gets stuck in the middle and impairs the erection).
Each patient is different and should seek a clear picture of his own situation.
This is why elastography is so important.

#8

Please keep us updated. This could be an interesting development.

#9

Doesn’t explain why there is a period of supra-recovery after cessation of finasteride and then a big crash in most people. If it was only about fibrosis, then theoretically most people would get ed during treatment with finasteride yet they briefly recover after cessation(which doesn’t last long before the horrors happen)

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#10

It could be that for some of us, whatever happened with our hormones or androgen receptors or whatever has subsided but left a lasting effect (the fibrosis) and now the fibrosis is all that has to be taken care of.

#11

I have physical alterations that are visible by MRI in the internal penis area, like below the scrotum, that my doctor describes as “scar tissue”. Has anyone else had tissue alterations visible by MRI?

What is your doctor suggesting for treatment methods based on your penile elastography results?

#12

I think we are facing the same problem. My scar tissue was not visible by MRI, but it’s there.
I have been using a vacuum erectile device for several months with modest results. But I guess I would be much worse if I don’t use it.
It’s not likely that I will recover 100%, but PRP and shockwave can help. I will start with those treatments soon.

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#13

As I said, I am not a scientist and am not trying to find the universal cause for all PFS cases. Every patient is different: some may have had a crash, some not, some have fibrosis, some don’t.
If you have fibrosis, you should not waste time and take action as soon as possible.

#14

Have you used PRP or shockwave?

Apparently there are a few types of shockwave and have different levels of efficacy
One common type has zero effect where another type, not sure, has a good effect
But of course the good type is less common and harder to find
Does it really break up fibrosis?

#15

I have used shockwave. Six sessions during a month. I didn’t see great change.
But it seems I should do more sessions.
PRP can help, too

#16

I don’t think the kind of shockwave in that machine is really effective
There’s better albeit more expensive kinds that you have to search out for
Khera spoke about this on YouTube
I tried to contact him but no answer

I’d use the machine or facility that he’d give the OK on
I’m gonna try and contact him again and hopefully I get through

#17

What did your doctor suggest to you as treatment options? Interesting. Do you have any bends on penis? Or typical PFS shape changes?

#18

@aldo Do you have any idea if your issue and similar physical penile issues can explain the low semen volume? Do you have lowered semen volume?

#19

I don’t have that issue.
It could be a different problem that you will need to address separately

#20

I have Viagra as needed. No bends in penis, no change in shape or size. I get pelvic floor physical therapy 1-2 times a month. The PT helps as I would get pain and soreness in my pelvic floor before. The PT has also helped improve my erectile functioning.

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