US Imaging in Peyronie's Disease

Abstract

The aim of this study is to assess the role of ultrasound (US) in Peyronie's Disease (PD). PD is a psychologically and physically devastating disorder that manifests in middle-aged men. Fibrous inelastic plaques in the tunica albuginea, result in palpable penile scar in the flaccid condition and cause painful erections and penile deformity, including penile curvature, hinging, narrowing, and shortening of penis. Penile deformity is the most common (52%) first symptom of PD and is present in 94% of affected men. US is the primary imaging modality of choice due to its easy availability, low risk, and ability to image and quantify both calcified and soft tissue elements of PD. US provides identification of smaller and non-palpable lesions and shows the extent of fibrosis. Detection of calcifications within the plaque suggests stabilization of the disease and provides information useful to select patients for appropriate treatment.

Penile Sonoelastography for the Localization of a Non-Palpable, Non-Sonographically Visualized Lesion in a Patient with Penile Curvature from Peyronie's Disease

“…Peyronie's disease is an inflammatory process, histologically characterized by chronic lymphocytic and plasmacytic infiltration, leading to fibrosis of the tunica albuginea of the phallus and penile curvature during erection [1]. The fibrosis is usually detectable as an indurated plaque by palpation or by radiographic findings [2,3]. Peyronie's disease is common, with reports of it affecting 3–9% of men [2,4], yet there is speculation that the prevalence is much higher because of men underreporting their symptoms [1,4].…”

“…The fibrosis is usually detectable as an indurated plaque by palpation or by radiographic findings [2,3]. Peyronie's disease is common, with reports of it affecting 3–9% of men [2,4], yet there is speculation that the prevalence is much higher because of men underreporting their symptoms [1,4]. Although it may be precipitated by traumatic intercourse or injury, up to 70% of cases do not stem from an inciting event, and the exact pathophysiology leading to the disease is unknown [5].…”

“…Assessments of curvature are best made with pharmacostimulated erections [6–8]. Penile curvature is sometimes present without a palpable plaque [2,3]. Ultrasound is the primary imaging technique in the evaluation of Peyronie's penile pathology and has a role in demonstrating calcifications in lesions and, with duplex studies, identifying potential concomitant vascular compromise [2,6,7].…”

“…Penile curvature is sometimes present without a palpable plaque [2,3]. Ultrasound is the primary imaging technique in the evaluation of Peyronie's penile pathology and has a role in demonstrating calcifications in lesions and, with duplex studies, identifying potential concomitant vascular compromise [2,6,7]. Case series have reported the detection of penile plaques with B‐mode ultrasonography in 39% to 97% of cases [3,9].…”

Cavernosopatía traumática crónica. Un nuevo síndrome de fibrosis peneana

“…26,27 Sin embargo, la teoría más relevante hoy para explicar la fibrosis peneana, en general, es la del trauma, la cual afirma que el MSR que sufre el pene durante la actividad sexual provoca una respuesta inflamatoria crónica que evoluciona a fibrosis de diversos grados y cambios en la matriz extracelular, en individuos que pueden o no estar genéticamente predispuestos. 12,24,25,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] En el presente estudio se han propuesto 2 escenarios potenciales que generan fibrosis: el secundario a traumas mayores del pene (excluidos en este estudio) y el de la fibrosis secundaria, muy posiblemente relacionada con MSR, que fueron incluidos. Como fuente de esos microtraumas existen 2 opciones reconocidas: los secundarios a erección parcial (menor de 7/10), que implican debilitar un instrumento rectilíneo que debe vencer las fuerzas axiales que se le oponen en vagina o ano, y los secundarios a curvaturas mayores de 30°; ambos escenarios angulan (o hiperangulan) el pene durante la penetración y generan un roce traumático (MSR) contra las paredes de la vagina, lo que potencialmente genera un daño o noxa que se traduce en fibrosis ulterior.…”