Dermatologic Manifestations of Peyronie Disease Workup

Updated: Jun 19, 2018
  • Author: Anne Elizabeth Laumann, MBChB, MRCP(UK), FAAD; Chief Editor: Dirk M Elston, MD  more...
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Workup

Imaging Studies

The diagnosis of Peyronie disease is based on the features of the history and the physical examination findings.

Radiographs depict plaque calcifications in 20% of patients. The presence of calcifications indicates advanced disease that is unlikely to regress spontaneously. Calcifications on radiographs are an indication for surgical intervention.

Doppler studies and dynamic-infusion pharmacocavernosometry can be performed on an artificially erect penis (see Procedures) to further identify lesions and any secondary filling defects.

High-resolution ultrasonography is the definitive imaging study, although it is not frequently required to confirm the diagnosis. Ultrasonography may be helpful before surgical intervention is planned.

MRI of the plaques is experimental and not performed routinely. It can be used to delineate inflamed plaques that are too soft or not dense enough to be detected with ultrasonography or radiography. [8, 9]

The positive results using scintigraphy with technetium Tc 99m human immunoglobulin G may correlate with unstable plaques that may respond to medical treatment. The lack of 99mTc human immunoglobulin G positivity may correlate with stable plaques, which are usually considered resistant to medical therapy and better suited for surgical intervention. [10]

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Procedures

Diagnostic intracorporeal injection may be used if the history is not clear or if a comorbid disease is present. An intracorporeal injection of a vasodilator may be used to determine the patient's erectile capability and the extent of penile distortion. Alprostadil (prostaglandin E1) or various combinations of alprostadil, phentolamine, and/or papaverine can be used to induce this artificial erection. [11]

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Histologic Findings

In early Peyronie disease, an inflammatory reaction occurs, with thickening of the tunica albuginea, deposition of fibrin, and loss of elastic fibers. Soon, nodular and/or diffuse bands of fibroblasts and myofibroblasts are surrounded by dense masses of collagen. These changes may extend into the underlying corpora cavernosa. Late-stage calcification or ossification may be seen.

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