Measurement of Penile Curvature in Peyronie’s Disease Patients: Comparison of Three Methods

Ohebshalom, Michael; Mulhall, John P.; Guhring, Patricia; Parker, Marilyn

doi:10.1111/j.1743-6109.2006.00404.x

Cited by 81 publications

(63 citation statements)

References 12 publications

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“…66 In the flaccid state, the clinician should determine stretched penile length and note palpable penile plaque location and size. Men should also be examined with the penis erect, which can be most effectively accomplished using intracavernosal injection of vasoactive substances 67 . Concurrent use of duplex Doppler penile ultrasound allows for objective evaluation of plaque size, location, and calcification, and aids in determination of ED etiology if ED is concurrently present.…”

Section: Discussionmentioning

confidence: 99%

Peyronie’s Disease: A Review of Etiology, Diagnosis, and Management

Bilgutay

Pastuszak

2015

Curr Sex Health Rep

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Peyronie’s Disease (PD) is a superficial fibrosing disorder of the penis resulting in plaque formation and penile deformity. Once considered rare, PD has more recently been found in up to 13% of men, and can negatively affect sexual and psychosocial function of both patients and their partners. While the etiology of PD is unclear, it is thought to result from an inciting traumatic event followed by aberrant fibrosis or dysregulated wound healing. The evaluation of men presenting with PD includes a detailed history and physical exam, focusing on the penis in both the flaccid and erect states. PD is often associated with erectile dysfunction (ED), as well as several other comorbidities. Laboratory testing is not needed to diagnose PD, although given the associations between PD and systemic diseases including hypogonadism, diabetes, and cardiovascular disease, screening and work-up for these conditions in men with PD may be warranted. Treatment modalities for PD are diverse and include oral, topical, intralesional, mechanical, and surgical therapies. Oral, topical, and mechanical therapies generally have little evidence supporting their efficacy. Several intralesional therapies, including interferon α2b and collagenase Clostridium hystiolyticum have demonstrated efficacy in the treatment of PD. Surgical treatment, indicated in men with significant, stable deformity, includes plication of the tunica albuginea, plaque incision/excision and grafting, and placement of inflatable penile prosthesis (IPP) with or without additional maneuvers to achieve desired results, and has high success rates.

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Section: Discussionmentioning

confidence: 99%

Peyronie’s Disease: A Review of Etiology, Diagnosis, and Management

Bilgutay

Pastuszak

2015

Curr Sex Health Rep

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“…Pharmacologically induced erection via injection of vasoactive agent such as papaverine alone, Tri-Mix (papaverine, phentolamine and prostaglandin E1), or prostaglandin alone is the most reliable method when compared to vacuum induced or photograph of office or home erection. 15 This is also useful as it is an indicator of vascular integrity and erectile response to the injected vasoactive drug. If a full erection does not occur, redosing is recommended to try to obtain an erection which is equal to or better than that which can be obtained at home with sexual stimulation.…”

Section: Preoperative Evaluationmentioning

confidence: 99%

Surgery for Peyronie's disease

Levine¹,

Larsen²

2012

Asian J Androl

110

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Peyronie's disease (PD) is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing and shortening, which may compromise sexual function. Although a variety of non-surgical treatments have been suggested, none to date offer a reliable and effective correction of the penile deformity. As a result, surgery remains the gold standard treatment option, offering the most rapid and reliable treatment which will be the focus of this article. We review the preoperative evaluation, surgical algorithm, graft materials and postoperative management of PD. Outcomes for tunical shortening, tunical lengthening and penile prosthesis placement for penile straightening are reviewed. Tunica albuginea plication is the preferred method of straightening for men with adequate rigidity and less severe disease defined as curvature less than 706 without narrowing/hinging. Men who have more severe, complex deformity, but maintain strong preoperative erectile function should be considered candidates for straightening with plaque incision or partial excision and grafting. Finally, for those men who have inadequate rigidity and PD, penile prosthesis placement with straightening is the best approach to address both problems. Keywords: penile prosthesis; Peyronie's disease, penile reconstruction; plaque excision and grafting; plaque incision; tunica albuginea plication INTRODUCTION Peyronie's disease (PD) is most simply referred to as a fibrotic woundhealing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing, shortening and painful erections. 1 The perceived loss of length and girth is often more disturbing than the curvature itself, all of which can lead to moderate to severe depressive symptoms, emotional, and relationship problems. 2,3 Despite a myriad of treatment options, PD remains a considerable therapeutic dilemma due to several factors including an incomplete understanding of its etiopathophysiology and the relative paucity of randomized, placebo-controlled trials. A general explanation of this disorder, which has gained acceptance, is that PD is a disorder in which genetically susceptible individuals experience a localized response to endogenous factors such as tumor growth factor-b, which are released in response to microtrauma. This can lead to biological transformation of cells within the tunica albuginea, cell cycle dysregulation, genotypic changes and increased expression of cytokines and free radicals. This inflammatory response leads to unregulated extracellular matrix deposition including fibronectin and collagen, and ultimately plaque scar formation, which does not appear to undergo proper scar remodeling, leaving an inelastic segment in the involved tunica albuginea. [4][5][6][7][8][9] Although a variety of non-surgical treatments have been suggested, none offer a r...

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“…Whilst it is common practice to delay surgery until the degree of deformity has been stable for several months, most urologists rely on the patient's observation to establish stability. A few units actually perform objective measurements of angulation [6,7,12] but not the erect penile length, which equally matters to the patient. While it is imperative that patients are warned about the risk of shortening following penile corrective surgery, it is also important that they are made aware of the natural history of disease progression with worsening or continuing of shortening in the postoperative years.…”

Section: Discussionmentioning

confidence: 99%

Is Penile Shortening Part of Natural History of Peyronie’s Disease?

Chitale¹,

Morsey²,

Sethia³

2010

TOUNJ

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Introduction/Aims: We have studied the natural history of Peyronie's disease with particular reference to erect (functional) penile length. To our knowledge this has so far not been documented.Methods: 21 men with stable Peyronie's deformity were followed up for 6 months when no active treatment was being offered. By inducing an artificial erection objective assessments of penile length and deformity were made on day 1 and at six months.Results: Measurable shortening in straight penile length was noticed in 6/21 (28.5%) of men (Mean: 0.92 cm), lengthening in 8/21 (38.09%) of men (Mean: 0.81 cm), while no change was noticed in the remaining 7 (33.3%).Angulation increased (worsened) in 5 (23.8%), decreased (improved) in 11 (52.38%) and showed no change in 5 (23.8%). There was no association between change in angle of deformity and change in penile length.Conclusions: In Peyronie's disease, a progressive reduction in penile length is noticed in up to a third of patients with stable disease and this is not necessarily associated with deteriorating angle of deformity.

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Measurement of Penile Curvature in Peyronie’s Disease Patients: Comparison of Three Methods

Cited by 81 publications

References 12 publications

Peyronie’s Disease: A Review of Etiology, Diagnosis, and Management

Peyronie’s Disease: A Review of Etiology, Diagnosis, and Management

Surgery for Peyronie's disease

Is Penile Shortening Part of Natural History of Peyronie’s Disease?

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