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

How we Utilize Imaging in the Management of Peyronie's Disease

At our center, we see over 150 new patients for Peyronie's disease each year. After initial consultation, where we collect a thorough history and physical examination, we obtain PDU on almost all Peyronie's disease patients. We do not obtain CT, MRI, or other adjunct imaging in routine clinical practice. Routine use of PDU is supported by a 2018 survey of International Society for Sexual Medicine (IISM) members: PDU was more likely to be used in Peyronie's disease management by higher volume surgeons who performed greater than 20 cases/year.[29] In accordance with the 2015 AUA guideline, we perform PDU in combination of ICI when evaluating the curvature deformity.[3] We prefer to evaluate Peyronie's disease plaques initially in the flaccid state because once erect, the curvature can interfere with the ultrasonography probe's contact to skin. There is no expert consensus on what information should be obtained regarding plaque descriptions,[29] but as a standard, we measure degree and direction of curvature, plaque location (ventral, dorsal, lateral) and distance from corona. We take particular care in assessing for calcification as this is associated with higher risk of progression to surgery[30,31] and treatment failure with Collagenase clostridium histolyticum (CCH).[32] In our clinical practice, we see calcification in nearly 70% of Peyronie's disease patients, which is higher than reported in the literature. How this impacts treatment success at our institution is currently under investigation.

We find PDU beneficial in men who have difficulty defining the cause of their erectile dysfunction, and those who are no longer sexually active secondary to curvature prohibiting penetrative intercourse. The 2018 AUA guideline on erectile dysfunction recommends PDU in situations where the additional data may be useful, such as differentiating psychogenic and organic erectile dysfunction, assessing arterial function in men with predominantly vascular erectile dysfunction, identification of severe veno-occlusive disease where medications are unlikely to work, and identification of men who may be candidates for revascularization procedures.[33] Key parameters derived from PDU include peak systolic velocity and end diastolic velocity. Generally, a Peak systolic velocity (PSV) less than 30 cm/s is considered evidence of arterial insufficiency (arteriogenic or vascular erectile dysfunction) and End diastolic velocity (EDV) more than 5 cm/s is consistent with veno-occlusive dysfunction. Patients with both Peyronie's disease and erectile dysfunction are recommended penile prosthesis, whereas those with normal vascular parameters are recommend reconstructive surgery or CCh (Figure 2).

Figure 2.

Management algorithm for Peyronie's disease using penile Doppler ultrasound.

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