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What is necrosis of the penis ?

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Practicing since : 2002
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Please if possible and necessary, read first and than answer urgently to the last question first - about whether I got necrosis of the penis.
I am 45 years old. About 5 months ago, i had penis injury after which I temporarily lost erectile function. I think psychological reasons - stress contributed much to this also - my Doctor probably thought it was more or less the only reason, but I know it was not. It seemed similar to fracture of penis, but the bent which was directed down - toward direction of my feet, was few centimeters away of my body, was seen only in semi erect state, since when the penis was fully erect, it was straight. After several months the erection returned completely but the bent in semi erect state was still there, and the sensitivity was still little smaller, so I decided to go to already appointed Doppler ultrasound test.
I got 20 ml caverject injection in the penis and I waited with full erection for about 4 hours, after that penis flattened. I waited that long since I was told to find help only if erection persist for 4 or 5 hours - this was a big mistake, it was too long – obviously wrong medical doctrine. The real problems started here. I still got few erections days latter, but they were weaker and weaker every next day, the penis seemed more rigid flaccid or erect, my morning erections also weakened until they vanished completely. I had pains in the penis and perineum. Before two months passed I was more or less impotent. Sensitivity was lost in in very great extent.
But now I have found another problem that may be even more serious. About 2 or 3 millimeters above the edge of the penis glans sometimes two incisions appear maybe each a good centimeter long, which were parallel to the edge of the glans; both goes from the middle line of the penis one to the left other to the right. In these two incisions some garbage of dark color appears from time to time, as If it is secretion from the disintegrating glans tissue. It seems as the glans is disintegrating inside, slowly losing its volume. The same kind of garbage appears just bellow penis glans under prepuce. Sometimes glans becomes cold.
Therefore I think the most urgent question is, weather this is necrosis, how urgent it is and how to test it and stop it. Would remedies that increase blood flow to the penis help? I had took first one yesterday and found that the area around incisions feels burning. When I was at my Doctor the incisions were obvious so I could not convince him that something was wrong. Please answer to this question promptly, leave the rest for later.
Posted Tue, 8 May 2012 in Penis Problems
Answered by Dr. Robert Galamaga 3 hours later
Hello and thank you for your query.

Let me start off by urging you to seek the advice of a local urologist who specializes in the health and function of the male reproductive and urinary system. Only a good clinical exam as well as perhaps an additional ultrasound flow study will give you true answers regarding your condition. I am not clear as to what you are referring to as incisions. Did you have some kind of procedure where a cutting instrument was used on the penis? Was there some other trauma to the glans that would create these incisions?

I know this must be very frustrating and difficult for you to endure, but in order to set your mind at ease, I feel you need to be seen by an expert. I would consider necrosis to be unlikely as you would have quite a bit of swelling, pain and even fever if that were the case.

I await your reply as we move forward to try and understand what is going on. Thank you again for your query.

Dr. Robert
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Follow-up: What is necrosis of the penis ? 3 hours later
With incision or channel I mean a pretty tin line where glans surface is pushed toward inside of glans let say for a mm or two. There was no procedure, doctor who made Doppler ultrasound test only gave me paper to sign, that if erection exceeds 5 hours (which is way too long I suppose), I should find urologist - terrible treatment - and she said I may go. The erection stayed for about 4 hours than it has gone and I left.
The 'cannels' on the glans happened by itself, there was additional trauma except priapism, since the glans is usually dry and somehow wrinkled. Every think seems dead, no moisture no bloody redness, pale look. Skin of the penis looks darker, loose and old. In these small 'channels' some rubbish appeared few times as if coming from inside of the glans and fill the channels. If the circulation increases - when I worm up penis with worm water for example, channels are temporarily smoothed out, not seen. But I am afraid that glans is getting thinner since the edge looks more turned up like a war helmet. When I have been at my local Doctor, 'channels' were not seen (I wrongly said last tiem that he seen them ) and He said that it is nothing special.

If it is not necrosis, is it some product of inner injuries which are coming out through glans skin from time to time? I think it is not dirt. I am really worried as it seems as my symptoms are comparable with symptoms of much longer priapism which usually means total and permanent impotence. Since the urologist who sent me to Doppler test wrote I should wait 4 hours with erection, I have reservation to visit him again. Do you agree that this is too long and do you think that can cause permanent damage? It probably depends on many factors. You are saying I need to repeat examination that put me into trouble. I wonder if injection into penis would this time make erection at all. What is the simplest diagnostic method with wich can be necrosis ruled out, probably erection is not needed for that.

I believe that depression can make man impotent it probably can’t make penis insensitive, pretty hard even flaccid and so on. Why did I had some erection after priapism, but they declined after. What causes so complete impotence. I intent to visit some urologist again, but I wonder If I need to hurry to avoid losing not only function but penis itself.

Answered by Dr. Robert Galamaga 4 hours later
Thanks for your followup.

Your problem is not an easy one and I sympathize with you along those lines. Can you seek an opinion of another urologist who can give you a fresh opinion? I really think that is the key in this case. The rubbish you refer to could be sweat and skin cells coming out or possibly a superficial infection.

Depression cancertainly affect erectile function as can anxiety. I honestly would not wait much longer to have this looked at. Why speculate when there may be a medical professional who can do a focused exam and give you the correct information. Try not to worry about permanent loss of function - this is not likely and will only cause you more anxiety as you think about it.

I again hope I have been helpful to you. I am still available for followup as well.

Dr. Robert.
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