IS Case 1: Peyronie's Disease
Imaging Sciences URMC 2008
Publication Date: 2009-05-18
History
Incidental finding of penile calcifications on CT. On further questioning patient reported difficulty maintaining erection.
Findings
Calcified curvilinear plaque on the medialdorsal tunica albuginea of the left corpus cavernosum.
Diagnosis
Peyronie's Disease
Discussion
Peyronie’s disease (PD, induratio penis plastica) is a benign condition of unknown etiology. The incidence is stated to be 1 to 3.2 %. The symptoms are penile deviation and painful erection in association with tunica albuginea plaques. Most common presentation is penile angulation, which is seen in 84% of cases. Up to 41% of patients experience erectile dysfunction either due to buckling or lack of rigidity due to vascular compromise distal to plaque. Association with HLA-B7, family history of PD in 2% of patients, and Dupuytren’s palmar fibromatosis in 20% suggest genetic predisposition. The other contributing factors include trauma, abnormal healing, collagen vascular, autoimmune, and arterial disease. The disease is divided into two phases: acute and chronic. The acute phase usually lasts for the first 18-24 months and is characterized by a changing inflammatory pattern that may include penile pain, penile deviation, and a penile nodule. The chronic phase is characterized by a stable plaque, often with calcification, and penile angulation. Spontaneous resolution is seen in 13% of men, stable disease is seen in 47%, and progression is seen in 40%. After plaque becomes calcified the angulation stabilizes. The diagnosis is performed by palpation of the penis. While CT can be used to assess for presence of calcified plaque, the plaque location and geometry can be further evaluated with MRI or US. Ultrasound is done using 7–12 MHz transducer. In the active state of disease associated with pain, hyperemia adjacent to the plaque can be visualized using Doppler US. Some authors advocate vascular US evaluation after intracavernosal injection of 20 ug of prostaglandin E1. Intervention is usually initiated by onset of erectile dysfunction. The medical therapy is indicated if the diagnosis is made within 6 months of onset of symptoms and is continued for at least 6 months. The proposed therapies include various combinations of mechanical stretching devices, colchicine and antibiotics. Once the plaque calcifies the medical therapy is believed not to be effective. Surgical excision of the plaque with variety of patches is usually used. The complete penile straightening is seen in 80 to 93% of cases. However, penile shortening is reported in 17 to 50 % of cases. Occasionally, penile prosthesis is placed at the time of the surgery to improve sexual function.
References
- Fornara P, Gerbershagen HP. Ultrasound in patients affected with Peyronie's disease. World J Urol. 2004 Nov;22(5):365-7. [PMID: 15672280]
- # Lizza E, Bruno JJ, II. Peyronie Disease. eMedicine, January 28, 2005. http://www.emedicine.com/med/topic3422.htm
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