Management of Peyronie's Disease in the Aging Male

Rany Shamloul; Anthony J Bella

Disclosures

Aging Health. 2011;7(1):65-78. 

In This Article

Diagnosis & Assessment

Diagnosis is usually apparent from patient history and penile examination. Patients can be given a preliminary diagnosis of PD when they present with classic symptoms of the disease: penile nodules (plaques), curvature and/or pain. Possible associated disorders (e.g., Dupuytren's contractures or vascular disease), and inciting events (e.g., trauma or genitourinary instrumentation), should be evaluated. It is important to define the psychological effect of PD on the patient and partner, as well as to determine the extent of associated ED using a validated questionnaire (e.g., The International Index of Erectile Function-5 questionnaire [IIEF-5]).

Objectively, clinicians may measure penile length, plaque size and penile curvature (Figure 1). In classical PD, a well-defined plaque or induration is palpable on physical examination, even if the patient is unaware. Among men with PD affecting the dorsal side of the penis, two-thirds will have associated plaque.[18] Lateral or ventral plaques are less common but, when present, can result in more coital difficulties. Plaques primarily located in the penile septum, or equally distributed on both the ventral and dorsal aspects of the penis, may cause penile shortening without angulation.[19] Septal (or core) plaques may not be palpable; therefore, in a man with penile shortening and pain with erection, but no angulation deformity, PD cannot be ruled out, and ultrasound examination may be useful. Abnormal tissue may extend beyond the palpable lesion, or even into the corporal tissue or intercavernosal septum.[20] The presence of multiple plaques located on opposite sides of the penis or septal plaques may cause penile shortening, with or without a penile deformity.[21] Calcification may occur at initial presentation or develop over time. It is often helpful to have the patient take photographs of the erect penis at home to characterize the deformity, although if the erection is not of good quality, determination of deformity will be inaccurate. If the patient cannot, or will not do this, in-office pharmacoerection can be performed, which is also useful for definitive management (surgery) planning.

If the diagnosis of PD is uncertain after history and physical examination, imaging may be helpful. Various imaging modalities have been used to diagnose PD. Ultrasound has the highest sensitivity for plaques in the tunica albuguinea compared with other methods.[1,22] Ultrasonography has additional advantages, owing to its easy availability, low risk and ability to image and quantify both calcified and soft-tissue elements of PD, as well as assess vascular status if a reconstructive procedure is being considered. However, ultrasound is operator dependent, and if inexperienced with PD, scant useful information may be obtained. Patients with PD and concomitant ED should undergo vascular assessment of their cavernosal arterial blood flow using duplex ultrasound.[23] There is little evidence for plain radiography, computerized tomography or magnetic resonance for diagnosis and investigation of PD.[1]

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