Peyronie’s Disease is a common, sexually debilitating fibrosing disorder of the penis that results in plaque formation and subsequent penile deformity. Once considered a rare condition, it can be found in up to 13% of men, with negative consequences on psychosocial and sexual functioning of affected men and their partners.
Currently, only surgical approaches show excellent results, although recent advances in therapy hold great promise for reducing deformity and improving function. Therefore, it is pivotal to obtain all the necessary information from patients and conduct necessary diagnostic procedures in order to individually tailor treatment regimens.
Medical History and Physical Evaluation
A review of a patient presenting with Peyronie’s disease should always include the duration of the condition and eventual presence or resolution of pain. Valuable insights can be gained by obtaining information about sexual practices, eventual presence of co-morbidities (hypertension, hypercholesterolemia, diabetes), as well as the existence of any vascular risk factors for erectile dysfunction.
A proper physical examination should entail a general appraisal of the femoral pulses, while the hands and feet should be thoroughly checked to confirm or exclude possible Dupuytren’s contracture or Ledderhose disease (plantar fibromatosis). However, the most important part of physical evaluation is the inspection of the patient’s penis.
First of all, the physician will evaluate the appearance of the penis in a flaccid state, and check whether it is circumcised. A measurement of penile length (pubis-to-glans length), girth and rigidity during erection will ensue. Appropriate assessment of erectile tissue is often done by penile shaft stretching.
This is followed by the evaluation of the penile curvature and plaques. The degree of curvature ranges from practically straight (which is approximately 15 degrees) to 180 degrees in severe forms of the disease. Even though dorsal curving is most commonly observed, the direction may be ventral, lateral or complex as well.
Plaques are associated with Peyronie’s disease and other penile deformities, and can be present as single or multiple changes. Usually the most straightforward way to recognize plaques is palpation, as 82% of all plaques are larger than 1.5 centimeters in diameter. That way the degree of plaque calcification can also be estimated.
Laboratory and Imaging Studies
Although the association between Peyronie’s disease and a plethora of histocompatibility antigens has been demonstrated (as well as with anti-DNA, antielastin and antinuclear antibodies), thus far none of them are being used as a specific marker for this disease. Therefore, the role of the laboratory in diagnosing this condition is negligible.
However, imaging of penile shaft can be a noteworthy endeavor in the diagnosis of Peyronie’s disease, as it can assess the level of plaque calcification, as well as signify the terminal point of chronic stage of the disease where no further angulation can be seen.
Conventional radiography (i.e. imaging using X-rays) may be employed to identify calcified plaques in the soft tissue, although this can also be supplemented with computerized tomography to pinpoint non-calcified plaques. While magnetic resonance imaging (MRI) is a quite effective alternative for observing plaques in the early stages of the disease and may be helpful in questionable cases, it is seldom used due to its cost.
A much more cost-effective approach is high-resolution penile ultrasound, especially for calcified plaques, with the detection rate up to 95%. For patients with concomitant Peyronie’s disease and erectile dysfunction, ultrasonography can be complemented with the injection of certain vasoactive substances into cavernous bodies of the penis to evaluate arterial flows.