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]

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]

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.

Treatment & Management

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Media Gallery

Lateral view demonstrates vertical curvature.
Superior view shows a full erection.
Postoperative picture after surgical repair demonstrates a straight erection.
Intraoperative picture of an artificial erection demonstrating lateral curvature.
Intraoperative picture after penile plication demonstrating a straight erection.

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Author

Anne Elizabeth Laumann, MBChB, MRCP(UK), FAAD Professor Emerita of Dermatology, Northwestern University, The Feinberg School of Medicine

Anne Elizabeth Laumann, MBChB, MRCP(UK), FAAD is a member of the following medical societies: American Academy of Dermatology, American Academy of Dermatology Association, American College of Wound Healing and Tissue Repair, American Dermato-Epidemiology Network, Association for Psychoneurocutaneous Medicine of North America, Association of Professors of Dermatology, British Association of Dermatologists, Chicago Dermatological Society, Chicago Medical Society, Dermatology Foundation, European Society of Tattoo and Pigment Research, Illinois Dermatological Society, Illinois State Medical Society, Institute of Medicine of Chicago, Lupus Foundation of America, Illinois Chapter, Medical Dermatology Society, National Psoriasis Foundation, National Vitiligo Foundation, North American Rheumatologic Dermatology Society, Rheumatologic Dermatology Society, Scleroderma Foundation, Society for Investigative Dermatology, The Global Fibrosis Foundation, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Joseph J Pariser, MD Assistant Professor of Urology, Department of Urology, University of Minnesota Medical School

Disclosure: Nothing to disclose.

Victoria Godinez-Puig, MD Resident Physician, Department of Dermatology, Northwestern University, The Feinberg School of Medicine

Victoria Godinez-Puig, MD is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Gregory Bales, MD Associate Professor, Department of Surgery, Section of Urology, University of Chicago

Gregory Bales, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: Biogen US (Adjudicator for study entry cutaneous lupus erythematosus); Priovant (Adjudicator for entry into a dermatomyositis study); IQVIA (Serono - adjudicator for a study of cutaneous LE) <br/>Received honoraria from UpToDate for author/editor; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for these trust accounts for: Stocks held in various trust accounts: Allergen; Amgen; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble;; Celgene; Gilead; CVS; Walgreens; Bristol-Myers Squibb.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Jay W Zimmerman, MD, FAAD Consulting Physician, Berman Skin Institute, Palo Alto

Jay W Zimmerman, MD, FAAD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, California Medical Association

Disclosure: Received consulting fee from Allergan for consulting; Received consulting fee from Centocor for consulting; Received consulting fee from Galderma for consulting; Received consulting fee from Coria Labs for consulting.