The Role of Imaging in the Diagnosis and Management of Peyronie's Disease

Madhumita Parmar; John M. Masterson; Thomas A. Masterson III

Disclosures

Curr Opin Urol. 2020;30(3):283-289. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: Several imaging modalities exist for the assessment of Peyronie's disease. However, comprehensive recommendations for using these objective modalities based on large-scale evidence-based studies do not yet exist. Our objective is to evaluate current imaging techniques and provide a model that we follow in our clinic in the workup and management of Peyronie's disease.

Recent findings: Computed tomography and radiography excellently visualize penile plaque calcifications, and MRI adeptly identifies plaques in complex locations, such as the corporal septum. Ultrasonography has extensive applications in plaque localization and characterization. Used along with color Doppler ultrasound, it is capable of detecting vascular abnormalities. Sonoelastography is an emerging subtype of ultrasongraphy that utilizes elastic properties of tissue to identify penile plaques that may not be visualized with other modalities.

Summary: Ultrasonography is the preferred imaging modality in Peyronie's disease and noninvasively characterizes penile plaques and monitors plaque response to various treatments. At our center, we perform ultrasonography with intracavernosal injection in all patients with Peyronie's disease to evaluate the degree of curvature, plaque characteristics, and concomitant erectile dysfunction to better guide management decisions.

Introduction

Peyronie's disease is an acquired abnormality of the penis characterized by a fibrotic plaque within the tunica albuginea that leads to abnormal penile curvature. Peyronie's disease is often accompanied by inability to engage in penetrative intercourse, erectile dysfunction, and emotional and physical distress. Peyronie's disease affects up to 8.9% of the male population, with greater prevalence in older men.[1] The leading hypothesis on the cause of Peyronie's disease is repeated microtrauma to the tunica from buckling during intercourse in the erect or semierect state. This trauma causes an inflammatory cascade that results in the deposition of inelastic fibrin, collagen type I and III, and calcium. Treatments for Peyronie's disease range from conservative measures to invasive surgical treatments. Although diagnosis of Peyronie's disease appears to be 'straightforward,' selecting the ideal treatment is difficult. Conservative therapies, such as antiinflammatory medication improve pain but do not correct deformity. Intralesional injection of collagenase corrects curvature, but it is expensive and has adverse effects in nearly 80% of patients. Surgical therapies may straighten the penis, but plication risks penile shortening, grafting may worsen erectile dysfunction, and penile prosthesis risks infection.

Imaging may assist in diagnosis and management of Peyronie's disease. Multiple imaging modalities have been studied in the management of Peyronie's disease, including computed tomography (CT), radiography, MRI, and penile color Doppler ultrasound (PDU). PDU is a noninvasive imaging technology that allows the urologist to evaluate the structure and vasculature of the penis in an office setting. PDU has gained significant utilization since the 1990s because it evaluates the structure and vasculature of the penis in great detail.[2] In clinical urologic practice, PDU is commonly used to evaluate men with erectile dysfunction and Peyronie's disease.

Current American Urological Association (AUA) guidelines on the diagnosis and management recommend, but do not mandate, PDU be performed following in-office intracavernosal injection (ICI) test on all patients being evaluated for Peyronie's disease. In this review, we will discuss different imaging modalities used for the diagnosis and management of Peyronie's disease with particular emphasis on PDU, as this is the most widely used in routine clinical practice. We will additionally discuss how we incorporate PDU into our practice and the value that PDU provides.

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