Sonographic patterns of Peyronie's disease in patients with absence of palpable plaques

Abstract

PurposeNon-palpable isolated septal plaques of the penis are likely present in a significant number of patients affected by erectile dysfunction (ED) and penile pain without deformity or curvature. The aim of this study was to evaluate the ultrasound (US) patterns observed in patients investigated for ED or penile pain without curvature.Materials and MethodsWe reviewed the medical records of 386 patients who underwent an initial colour-Doppler ultrasonography (CDU) of the penis for DE and/or penile pain without curvature. After satisfying inclusion criteria, 41 patients were individualized. All patients had a non-palpable plaque with involvement of the penile septum. Three US patterns were identified: focal hyperecoic thickening of the intercavernosum septum (IS) with acoustic shadow (pattern 1), non-calcified thickening (isoechoic or slightly hyperechoic (pattern 2), and microcalcifications in the IS without associated acoustic shadow (pattern 3).ResultsPatients’ mean age was 51.3±16.7. ED was the predominant disorder in 73.2% of patients, followed by penile pain and length loss in 19.5% and 7.3% of patients, respectively. 32(78.1%) patients showed the pattern 1, 6 (14.6%) pattern 2, and 3 (7.3%) pattern 3. Plaques size varied from 3 to 13 mm. The penile hemodynamic response to CDU reported abnormal findings distally to the septal plaques in 20 patients (<25cm/sec). Median left and right cavernosum artery flows measured a peak systolic velocity of 31cm/sec and 33 cm/sec, respectively.ConclusionsWe believe that an US study with CDU provides a way to characterize, localize, and deliver treatment choice in patients with Peyronie's Disease.

Clinical Presentation of Peyronie’s Disease: A Retrospective Study of 564 Cases

“…In our series, plaque was not palpable in 10.9% of cases. This fits with previous reports from the scientific literature, where in some studies the percentages of non-palpable plaque ranged from 2.8 to 22.0% of cases [53,76,85,86]. We detected the presence of calcification in 35.6% of cases.…”

The Natural History of Peyronie's Disease

“…In some cases, non-palpable isolated septal plaques without deformity of the penis may be present. In such condition, ultrasonographic evaluation may allow earlier identification and treatment of occult septal injuries or lesions and prevent subsequent fibrosis and its associated symptoms [ 16 17 ]. Location of the plaque considerably differs across previous studies, being dorsal location the most frequent at disease onset ( Table 1 ) [ 18 19 20 21 ].…”