Erectile Dysfunction and Urinary Issues After Trauma

Erectile dysfunction and urinating with a tilt to the left?

Eight years ago, I sustained an injury to the lower right side of the base of my penis and right testicle, resulting in bruising and hematoma.
The right side of the base is very painful, and now my urine stream deviates to the left.
I can still achieve an erection even though I haven't hit my penis directly.
Previously, my penis was straight with visible blood vessels.
Could there be nerve damage, or has the corpus cavernosum been affected? Additionally, is there a possibility that the corpus spongiosum, which surrounds the urethra, has been injured? How should I treat this? I have visited major hospitals and undergone ultrasound examinations, but the medications prescribed by the doctor, including Calcitriol F50 and Sustained Release Membrane Tablets 400mg, have not been effective.

Kai, 40~49 year old female. Ask Date: 2023/04/13

Dr. Xu Wencang reply Urology

It is advisable to have a male health expert reassess.
Invasive angiography can be performed on the penile vasculature.

Reply Date: 2023/04/13

More Info

Erectile dysfunction (ED) and urinary issues following trauma to the genital area can be complex and multifactorial. In your case, the history of trauma to the penis and right testicle, along with the symptoms you are experiencing, suggests that there may be underlying damage to the vascular or nerve structures that are crucial for normal erectile function and urinary control.

Understanding the Anatomy and Impact of Trauma
The penis consists of three main erectile tissues: the two corpora cavernosa (which run along the top side of the penis) and the corpus spongiosum (which surrounds the urethra). Trauma to the penis can lead to bruising, hematoma formation, and potential damage to the blood vessels and nerves that supply these tissues. If the trauma was severe enough, it could result in conditions such as penile fracture or damage to the erectile tissues, leading to erectile dysfunction.

The symptoms you describe, such as the deviation of urine flow to the left and the pain in the right root of the penis, may indicate that there is some structural or functional impairment. The fact that you can still achieve an erection suggests that some erectile function remains, but the quality and directionality of the erection may be compromised due to the trauma.

Possible Causes of Your Symptoms
1. Vascular Damage: Trauma can lead to damage to the blood vessels supplying the penis, which can affect blood flow and result in erectile dysfunction. If the blood flow is compromised, it may also lead to difficulties in achieving or maintaining an erection.

2. Nerve Injury: The nerves that control erection and sensation can be damaged during trauma. This can lead to changes in erectile function and may also affect urinary control.

3. Structural Changes: The trauma may have caused changes in the anatomy of the penis, such as scarring or fibrosis, which can affect both erectile function and the direction of urine flow.

4. Psychological Factors: Trauma can also have psychological effects, leading to anxiety or stress related to sexual performance, which can further complicate erectile function.

Treatment Options
1. Medical Evaluation: Since you have already undergone ultrasound examinations and have seen multiple doctors, it is crucial to ensure that a thorough evaluation has been conducted. This may include a detailed assessment of the vascular and nerve function in the area.

2. Medications: The medications you mentioned, such as phosphodiesterase type 5 inhibitors (like Viagra or Cialis), are commonly prescribed for erectile dysfunction. If these have not been effective, it may be worth discussing alternative treatments with your doctor.

3. Penile Rehabilitation: In some cases, penile rehabilitation programs involving vacuum erection devices or injections may help improve erectile function over time.

4. Surgical Options: If there is significant structural damage or if conservative treatments fail, surgical options may be considered. This could include penile prosthesis implantation or vascular surgery to improve blood flow.

5. Psychological Support: If there are psychological factors contributing to your symptoms, counseling or therapy may be beneficial.

Follow-Up and Monitoring
It is essential to maintain regular follow-ups with a urologist who specializes in sexual medicine or trauma-related injuries. They can provide ongoing assessment and adjust treatment plans as necessary. Given the complexity of your symptoms, a multidisciplinary approach involving urologists, psychologists, and possibly physical therapists may yield the best outcomes.

Conclusion
In summary, the trauma you experienced may have led to a combination of vascular, nerve, and structural changes that are contributing to your current erectile and urinary issues. A comprehensive evaluation and a tailored treatment plan are crucial for addressing these concerns. Open communication with your healthcare providers about your symptoms and treatment responses will be key to finding an effective solution.

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