Are Sonographic Characteristics Associated With Progression to Surgery in Men With Peyronie's Disease?

Abstract

Purpose Traditionally, diagnosis and treatment plans for Peyronie’s disease have been based on history and physical examination. Penile ultrasound provides rapid, anatomical information to establish disease severity, and to monitor progression and response to medical therapy. We determined the relationship between ultrasound characteristics and progression to surgical intervention in men with Peyronie’s disease. Materials and Methods We conducted a retrospective cohort study of 518 patients with Peyronie’s disease. Patients completed a Peyronie’s disease specific questionnaire detailing medical history, health related behaviors and Peyronie’s disease characteristics, and underwent sonographic evaluation of the penis. Measurements of subtunical calcifications, septal fibrosis, tunical thickening (tunica thickness greater than 2 mm) and intracavernous fibrosis were made. Progression to surgery was determined from the medical record. Results In this cohort (mean patient age 53.8 years, range 20 to 78) 31% of patients had calcifications, 50% had tunical thickening, 20% had septal fibrosis and 15% had intracavernous fibrosis. Overall 25% of the cohort progressed to surgical intervention after an average followup of 1.25 years (range 0 to 7.6). Patients who underwent surgery were more likely to have subtunical calcifications present at the first clinic visit (OR 1.75, 95% CI 1.16–2.62). No other sonographic characteristics were associated with progression to surgery. After adjustment for age, marital status, degree of curvature, additional penile deformity, difficulty with penetration, ability to have intercourse and prior treatment for Peyronie’s disease, calcifications were strongly associated with progression to surgery (OR 2.75, 95% CI 1.25–3.45). Conclusions In a large cohort of patients with Peyronie’s disease the presence of sonographically detected sub-tunical calcifications during the initial office evaluation was independently associated with subsequent surgical intervention.

Penile Doppler Sonographic and Clinical Characteristics in Peyronie's Disease and/or Erectile Dysfunction: An Analysis of 1500 Men With Sexual Dysfunction

“…The authors confirm what Smith et al [2] and Breyer et al [3] previously documented that the presence of intracavernosal fibrosis and tunical thickening were associated with a decreased ability to perform intercourse satisfactorily. The authors also confirm with others that tunical thickening and decreased blood flow was more common in older men, fibrosis was more common in the younger cohort and cardiovascular risk factors were associated with intracavernosal calcifications [4,5].…”

Penile Doppler sonographic and clinical characteristics in Peyronie's disease and/or erectile dysfunction: an analysis of 1500 men with male sexual dysfunction

“…[13] reported four distinct penile CDU findings in men with PD; namely, calcification, septal fibrosis, tunical thickening and intracavernosal fibrosis. The presence of intracavernosal fibrosis and tunical thickening were found to be associated with a decreased ability to have intercourse [8] while baseline calcifications on penile CDU correlated strongly with the progression to surgery [13]. Despite the inclusion of several risk factors of vasculogenic ED, an association with calcification on penile CDU was found only in men with diabetes (odds ratio 1.8, P = 0.06).…”

Relationship between penile fracture and Peyronie's disease: a prospective study

“…However the plaque is visualized as a hyperechogenic area without a single acoustic shadow in the acute phase, but with multiple acoustic shadows in the intermediate phase and a more intense hyperechogenic plaque-like lesion with acoustic shadows in the chronic phase. 27 PD is best viewed in T2-weighted images of MRI. Following the administration of intravenous gadolinium, formation of contrast on plaques indicates an active inflammation.…”