Q. I am 32 and can’t sustain a rigid erection for a long period of time. I’ve been to one doctor, two urologists, an impotence center and a psychologist and the only answer I have is a prescription of Viagra. The impotence center did thorough testing and determined I had a blood leak. An electrode rigid meter verified I did not have normal erections during sleep. I obtained two semi-erections, about 50 percent of normal. With Viagra I feel like I did when I was younger. However, I don’t want to depend on drugs the rest of my life. The alternatives seem to be a pump, MUSE or Caverject injections, which I find unacceptable. What do they do for blood leaks? Is there surgery to correct this?

A. I understand completely — I would not want lifelong medication either. I would like to give your urologists some credit because they at least did a complete workup and determined the cause of your problem.

A venous leak means that blood does not stay stored in the penis. An erection only stays hard as long as the penis stays full. Think of a car tire — when there is a small leak, it slowly loses pressure and goes flat. But you can fix the problem either by patching the leak or putting in air faster than it leaks out. Your doctor is doing the same thing to your penis.

MUSE (alprostadile) suppositories or Caverject (alprostadile) injections are both prostaglandin E1 derivatives that dilate the arteries and thus increase blood flow to the penis, overcoming the leak. These help you get an erection; unfortunately, it is not your own, nor is it as good.

The other option is to fix the leak with surgery. This to can be accomplished by a urologist who specializes in microsurgery of the penis. Such specialists can perform studies that will localize the exact leak point, and they may be able to perform surgery to tie off the leak. There are many in the United States; you should ask your doctor for a referral to one of them.

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