Peyronie disease
Updates to Article Attributes
Peyronie disease is the most common cause of painful penile induration2. Fibrous tissue plaques are formed within tunica albuginea, causing painful deformity and shortening of the penis. Though clinical diagnosis is usually accurate, role of imaging is to evaluate extension of plaques, whether the penile septum is involved, and to examine the relationship between the plaques and penile vasculature.
Epidemiology
Peyronie's disease disease incidence is 1% of erectile dysfunction cases2. It may be associated with injury during sexual activity.
Clinical features
- curved
/ bent/bent penis* - penile plaque
- decreased penile length
- less rigidity of penis
- penile numbness
- erectile dysfunction
- painful erection
* congenital curvature of penis is however different condition, seen in children and young adults, and does not cause any problem.
Associations
Peyronie disease is associated with out fibromatoses including plantar fibromatosis and Dupuytren's contractures contractures.
Radiographic features
Ultrasound
During pharmacologically induced erection, Peyronie plaques are identified as localized/diffuse thickening of tunica albuginea. Echogenic plaques are usually seen on dorsal aspect of penis, however they may also be seen on ventral aspect. Calcifications are also seen frequently sonographically.
Ultrasound can detect relationship of plaques and surrounding structures. Especially, involvement of neurovascular bundle is important, which can be seen as dorsal arteries embedded within the plaque. Cavernosal artery encasement is seen in cases of septal plaques. This arterial encasement can lead to erectile dysfunction (arteriogenic).
CT
content required
MRI
Plaques appear as thickened and hypo-intense signal areas on T1W and T2W images, in and around tunica albuginea. They are usually best seen on T2W images1 . However, albugineal calcifications are difficult to recognize. Contrast enhancement may or may not be seen in active inflammation. However, contrast enhancement is controversial1 .
Treatment and prognosis
Indication for surgical correction include severe bending or shortening of penis causing sexual difficulty. Procedures available for surgical correction are-
- shortening operations.
- plaque excision or incision with grafting
- prosthesis implantation
Penile shortening procedure provide excellent preservation of erectile function, however these procedures cause loss of penile length. Plaque excision on the other hand, are prone to erectile dysfunction. Prosthesis implant is indicated in severe Peyronie disease with erectile dysfunction.
Differential considerations
-
sclerosing lymphangitis of penis
- It: it is a superficial 'rope-like' lesion usually located at coronal sulcus, and on examination, seen as thrombosed vein. - congenital curvature of penis
-<p><strong>Peyronie disease </strong>is the most common cause of painful penile induration<sup>2</sup>. Fibrous tissue plaques are formed within tunica albuginea, causing painful deformity and shortening of the penis. Though clinical diagnosis is usually accurate, role of imaging is to evaluate extension of plaques, whether the penile septum is involved, and to examine the relationship between the plaques and penile vasculature.</p><h4>Epidemiology</h4><p>Peyronie's disease incidence is 1% of erectile dysfunction cases<sup>2</sup>. It may be associated with injury during sexual activity.</p><h4>Clinical features</h4><ul>-<li>curved / bent penis*</li>- +<p><strong>Peyronie disease </strong>is the most common cause of painful penile induration<sup>2</sup>. Fibrous tissue plaques are formed within tunica albuginea, causing painful deformity and shortening of the penis. Though clinical diagnosis is usually accurate, role of imaging is to evaluate extension of plaques, whether the penile septum is involved, and to examine the relationship between the plaques and penile vasculature.</p><h4>Epidemiology</h4><p>Peyronie disease incidence is 1% of erectile dysfunction cases <sup>2</sup>. It may be associated with injury during sexual activity.</p><h4>Clinical features</h4><ul>
- +<li>curved/bent penis*</li>
-</ul><p>* congenital curvature of penis is however different condition, seen in children and young adults, and does not cause any problem.</p><h4>Associations</h4><p>Peyronie disease is associated with out fibromatoses including <a title="Plantar fibromatosis" href="/articles/plantar-fibromatosis">plantar fibromatosis</a> and <a title="Dupuytren's contractures" href="/articles/dupuytren-contracture">Dupuytren's contractures</a>.</p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>During pharmacologically induced erection, Peyronie plaques are identified as localized/diffuse thickening of <a href="/articles/tunica-albuginea">tunica albuginea</a>. Echogenic plaques are usually seen on dorsal aspect of penis, however they may also be seen on ventral aspect. Calcifications are also seen frequently sonographically.</p><p>Ultrasound can detect relationship of plaques and surrounding structures. Especially, involvement of neurovascular bundle is important, which can be seen as dorsal arteries embedded within the plaque. Cavernosal artery encasement is seen in cases of septal plaques. This arterial encasement can lead to <a href="/articles/penile-doppler-in-erectile-dysfunction">erectile dysfunction</a> (arteriogenic).</p><h5>CT</h5><p>content required</p><h5>MRI</h5><p>Plaques appear as thickened and hypo-intense signal areas on T1W and T2W images, in and around tunica albuginea. They are usually best seen on T2W images<sup>1 </sup>. However, albugineal calcifications are difficult to recognize. Contrast enhancement may or may not be seen in active inflammation. However, contrast enhancement is controversial<sup>1 </sup>.</p><h4>Treatment and prognosis</h4><p>Indication for surgical correction include severe bending or shortening of penis causing sexual difficulty. Procedures available for surgical correction are-</p><ul>- +</ul><p>* congenital curvature of penis is however different condition, seen in children and young adults, and does not cause any problem.</p><h4>Associations</h4><p>Peyronie disease is associated with out fibromatoses including <a href="/articles/plantar-fibromatosis">plantar fibromatosis</a> and <a href="/articles/dupuytren-contracture">Dupuytren contractures</a>.</p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>During pharmacologically induced erection, Peyronie plaques are identified as localized/diffuse thickening of <a href="/articles/tunica-albuginea">tunica albuginea</a>. Echogenic plaques are usually seen on dorsal aspect of penis, however they may also be seen on ventral aspect. Calcifications are also seen frequently sonographically.</p><p>Ultrasound can detect relationship of plaques and surrounding structures. Especially, involvement of neurovascular bundle is important, which can be seen as dorsal arteries embedded within the plaque. Cavernosal artery encasement is seen in cases of septal plaques. This arterial encasement can lead to <a href="/articles/penile-doppler-in-erectile-dysfunction">erectile dysfunction</a> (arteriogenic).</p><h5>CT</h5><p>content required</p><h5>MRI</h5><p>Plaques appear as thickened and hypo-intense signal areas on T1W and T2W images, in and around tunica albuginea. They are usually best seen on T2W images<sup>1 </sup>. However, albugineal calcifications are difficult to recognize. Contrast enhancement may or may not be seen in active inflammation. However, contrast enhancement is controversial<sup>1 </sup>.</p><h4>Treatment and prognosis</h4><p>Indication for surgical correction include severe bending or shortening of penis causing sexual difficulty. Procedures available for surgical correction are-</p><ul>
-<a href="/articles/sclerosing-lymphangitis">sclerosing lymphangitis</a> of penis - It is a superficial 'rope-like' lesion usually located at coronal sulcus, and on examination, seen as thrombosed vein.</li>- +<a href="/articles/sclerosing-lymphangitis">sclerosing lymphangitis</a> of penis: it is a superficial 'rope-like' lesion usually located at coronal sulcus, and on examination, seen as thrombosed vein</li>
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