Management of Peyronie's disease--a review

 Peyronie's disease is an uncommon condition involving middle-aged men and probably resulting from penile trauma. The injury causes an inflammation in the tunica and ultimately scarring and penile curvature develop. It may also occur due to nonspecific inflammation. The use of medications such as β-blockers can sometimes result in Peyronie's disease. In Peyronie's disease, the normal elastic tissue of the tunica is replaced by scar tissue. The penile plaque, or scar tissue in this condition, is not elastic but hard and will not stretch with erection. The side that does not stretch results in penile curvature to the side of the scar. One third of men with Peyronie's disease have painful erections. A low percentage of men with Peyronie's disease develop erectile dysfunction. Because inflammation is initially associated with the scar tissue, some amount of discomfort occurs during erection. Most patients with early stage Peyronie's disease can continue to function sexually with the curvature in the penis. Others with a severe penile deformity will have difficulty in sexual intercourse. Literature regarding the effectiveness of conservative therapy in the early phase with pain and inflammation is limited, with only modest and at times anecdotal benefits. The commonly used agents include 400 units of vitamin E (vitamin E promotes healing and prevents scarring), ibuprofen (anti-inflammatory) and Colchicine (useful for pain during erection). Fexofenadine is recently being used in the early phase of Peyronie's disease for its anti-inflammatory effect. Radiation and ultrasound are not usually very helpful. When the disease process stops, there is usually some residual distortion of the penis but the majority of patients are able to have satisfactory sexual intercourse. However, if there is severe penile distortion interfering with intercourse, surgery is indicated. Surgical techniques for Peyronie's disease include tightening or plication (Nesbit's tuck) of the penis opposite the curvature to produce straightening. This usually results in some small loss of length. The other type of surgery consists of incision of the plaque or scar tissue and patching with a vein (saphenous vein graft) or dermal graft. Laser therapy is occasionally used. A penile prosthesis is the treatment of choice in patients with Peyronie's disease and erectile dysfunction.     

Management of Peyronie's disease with penile prostheses

Peyronie's disease is a common malady affecting men mostly between the ages of 40 and 60. When penile curvature and erectile softening are present and the erectile dysfunction does not respond to Viagra a penile implant will strengthen and usually straighten the penis. If curvature persists after implant placement 'modeling' the erect penis will successfully achieve straightening in most patients. Plaque incision and grafting or a Nesbit procedure are rarely necessary to straighten the penis but will afford excellent results when employed. A thorough explanation of the pathogenesis of Peyronie's disease and effects of the disease and treatment on penile size will help avoid some of the disappointment seen when a shorter erection occurs.     

Venogenic impotence following dermal graft repair for Peyronie's disease.

Peyronie's plaque excision with dermal grafting generally offers good cosmetic results for patients who require surgical intervention for Peyronie's disease. However, postoperative impotence has been reported in 12 to 100% of such patients. The mechanism of impotence in this setting is not well defined. We present 3 men who had venogenic impotence after plaque excision and dermal grafting for Peyronie's disease. One patient has subsequently responded well to dorsal vein ligation, 1 has chosen an effective nonoperative method of management and 1 continues to consider the options. We report venous leak as an organic cause of impotence after plaque excision and dermal grafting for Peyronie's disease, and its successful management by dorsal vein ligation. The implications of these findings in the surgical management of Peyronie's disease are discussed.     

Chromosomal instability is demonstrated by fibroblasts derived from the tunica of men with Peyronie's disease

Peyronie's disease is a fibrotic disorder, a condition characterized by cellular proliferation and excess extracellular matrix production. Previous work in related conditions has demonstrated chromosomal instability. This investigation was undertaken to analyze fibroblasts derived from Peyronie's disease tunical tissue for abnormalities of chromosome number and progression of cytogenetic aberrations during cell culture. Tunical tissue was excised from men with Peyronie's disease from both plaque and nonplaque tissue and cells were explanted in culture. Control cells were derived from both neonatal foreskins and normal tunica from men with congenital penile curvature. Fluorescent in situ hybridization was used to probe for chromosomes 7, 8, 17, 18, X and Y. Control cells demonstrated normal copy number for all chromosomes analyzed. In contrast, Peyronie's disease plaque-derived fibroblasts demonstrated frequent aneusomies in chromosomes 7, 8, 17, 18 and X and recurrent deletions of chromosome Y. Peyronie's disease nonplaque tunica-derived fibroblasts demonstrated infrequent chromosomal changes early in culture; however, with repeated passaging the majority of cell cultures demonstrated aneusomies in at least one chromosome. These data indicate that Peyronie's disease plaque-derived fibroblasts have consistent aneusomies even at early passage and that nonplaque tunica-derived cells from men with Peyronie's disease also demonstrate chromosomal instability. This suggests that the tunica albuginea of men with Peyronie's disease may be predisposed to undergoing unregulated fibrosis. These findings confirm the transformed nature of the Peyronie's disease tunical fibroblasts studied in this analysis. While the etiology of these findings is not clear, it is likely that these pathobiological characteristics contribute to the pathophysiology of this disease process.     

Prevalence of Peyronie's disease in men over 50-y-old from Southern Brazil

The pathogenesis of Peyronie's disease still remains an enigma and few epidemiological studies are available. The purpose of this study was to determine the prevalence of Peyronie's disease in males older than 50 y. From 26 to 30 July 1998, 1071 men attended the 'Prostate Cancer Awareness Week of Santa Casa Hospital, Porto Alegre, Brazil'. In the prostate exam they also consented to be screened for Peyronie's disease. They underwent the 5-item International Index of Erectile Function (IIEF-5) questionnaire for evaluation of the erectile condition. The presence of a well-defined plaque in the penis was the diagnostic criterion for Peyronie's disease. The men were examined by five senior residents, under supervision by the staff Urologist. Men younger than 50 y as well as patients under intracavernous injection therapy for erectile dysfunction were excluded from the study. Chi2 test was used for statistical analysis. Nine hundred and fifty-four (89.1%) out of the 1071 men with a mean age of 62 y (ranging from 52 to 77) were included in the study. Peyronie's disease plaques were found in 35 men (3.67%). Eight hundred and forty-five (88.6%) were Caucasians. There was no significant statistical difference regarding age (P > 0.05). The presence of erectile dysfunction in the men with Peyronie's disease and without this condition, was 68.6% and 53.5%, respectively (P > 0.05). From this data we can conclude that the prevalence of Peyronie's disease is higher than in formerly reported studies. Further observations should be carried out in different communities and in other groups of patients in order to confirm our results.     

Extracorporeal shockwave therapy for Peyronie's disease: who benefits?

BACKGROUND AND PURPOSE: Extracorporeal shockwave therapy (ESWT) has been reported to improve the symptoms of Peyronie's disease. However, the response rates to this treatment appear to be variable. This study aimed to determine whether any patient or plaque characteristics are associated with a better outcome. PATIENTS AND METHODS: A series of 36 patients with Peyronie's disease received ESWT as a primary treatment. Subjective response rates were compared on the basis of patient age, degree of pretreatment penile curvature, predisposing medical factors, duration of disease, and extent of plaque calcification. RESULTS: Ten men (27.8%) reported subjective improvements in curvature after ESWT. Of the factors considered, only age and pretreatment curvature influenced outcomes: 50% of the men below the mean age reported improvement compared with 5.6% of older men and 62.5% of men with mild curvature reported improvement compared with 8.3% of those with severe curvature. CONCLUSION: The response to EWST is not the same for all men with Peyronie's disease. Younger men and those with milder curvature have the best outcomes.     

A retrospective review of 307 men with Peyronie's disease

PURPOSE: We discuss the clinical appearance and natural outcome of Peyronie's disease. MATERIALS AND METHODS: During an 8-year period 307 men with Peyronie's disease were evaluated, and clinical characteristics, risk (factors), penile deformities, erectile status and outcome were analyzed. RESULTS: Mean patient age plus or minus standard deviation was 52.8 +/- 9.3 years (range 23 to 76). Penile deformity, pain on erection and palpable nodule were the most common (85%) presenting symptoms, usually in different combinations. The remaining 15% of men (mean age 59.4 +/- 6.5 years) were not aware of the penile deformity and were diagnosed during standard evaluation for erectile dysfunction. Dorsal (45.6%) and lateral (29.3%) were the most common curvatures. The degree of deformity was less than 30 degrees in 42.7% of patients, 31 to 60 degrees in 38.8% and greater than 60 degrees in 18.6%. At least 1 risk factor for systemic vascular disease was identified in 67.5% of patients, and hypercholesterolemia and diabetes were the most common. Patients with at least 1 risk factor had a significantly higher risk for severe penile deformity. Of the men 54.4% complained of erectile dysfunction and the probability of diminished erectile capacity was 86.7% in patients older than 60 years, with Peyronie's disease for more than 12 months and at least 1 risk factor. Of 63 patients presenting with the acute phase of disease penile deformity deteriorated in 30.2%, did not change in 66.7% and resolved spontaneously in 3.2% without any treatment after a mean followup of 8.4 months. CONCLUSIONS: Our data show that penile deformities are disabling (greater than 30 degrees) in 62.5% of cases. Risk factors, such as serum lipid abnormalities, diabetes and hypertension, seem to have significant impact on the severity of symptoms and outcome. Patients must be informed that Peyronie's disease is progressive in 30.2% without treatment and spontaneous resolution is rare.     

Prospective analysis of 16S rDNA as a highly sensitive marker for bacterial presence in Peyronie's disease plaques

PURPOSE: Previous studies have implicated an infectious agent induced pathogenesis in Peyronie's disease. To our knowledge an association with venereal diseases or other infectious diseases has not been demonstrated to date, although Peyronie's disease is an inflammatory disorder. In case of an infectious origin of the disorder bacteria or at least their fragments should occur in the plaque. We investigated prospectively the occurrence of 16S rDNA as a highly sensitive marker for the presence of bacteria in inflammatory processes. MATERIALS AND METHODS: In 19 patients with idiopathic Peyronie's disease biopsy of the tunica albuginea was sampled. A total of 16 men with no evidence of Peyronie's disease served as the control group. In these men tissue from the tunica albuginea was obtained during penile prosthesis implantation for erectile dysfunction or during a Nesbit procedure for congenital penile curvature. Screening for bacterial DNA was performed prospectively using a polymerase chain reaction targeting bacterial 16S rDNA. RESULTS: In the tunica albuginea specimen 16S rDNA was not detectable in patients with Peyronie's disease or in the control group. CONCLUSIONS: The results of this study do not indicate an association between Peyronie's disease and bacterial infection.     

Should assessment of penetrative sexual activity be used as the treatment arbiter in the management of Peyronie's disease?

Peyronie's disease is an inflammatory disorder, which causes thickening of the tunica albuginea of the penis. Peyronie's disease has a variable natural history and the assessment and management of the disease has yet to be standardised. The case notes of 97 patients with a diagnosis of Peyronie's disease were retrospectively reviewed at a single tertiary referral centre. Patients who were able to achieve sexual penetrative activity to the satisfaction of both partners were managed conservatively. Patients who were unable to achieve penetrative sexual activity were given intra-cavernosal prostaglandin, with those achieving a satisfactory erection being offered appropriate surgical intervention. The mean age at presentation was 50 years (range 18-82). A total of 59 (61%) men were able to have penetrative sex at the time of presentation. Following initial conservative management, only five (8%) of this group had disease progression, which stopped them from being able to penetrate. In all 38 (39%) men who were not able to penetrate at presentation were offered surgical intervention. In all 24 (63%) of these men chose to have surgical intervention. Tunical plication resulted in the ability to penetrate in 77% of men choosing this option whereas only 46% of men undergoing autologous saphenous vein grafting were able to have penetrative sex. Assessment of penetrative sexual function is an essential component of the management of patients with Peyronie's disease. This enables appropriate counselling with respect to possible conservative management or the most appropriate surgical intervention. The majority of patients with Peyronie's disease can achieve sexual penetrative activity, many without surgical intervention.     

The prevalence of Peyronie's disease: results of a large survey

OBJECTIVES: To determine the prevalence of Peyronie's disease, a localized connective tissue disorder of the penile tunica albuginea, the symptoms of which include palpable plaque, painful erections and curvature of the penis, in a large sample of men in Germany. SUBJECTS AND METHODS: A standardized questionnaire was sent to 8000 male inhabitants (age range 30-80 years) of the greater Cologne area (approximately 1.5 million inhabitants). Three questions about the self-diagnosis of Peyronie's disease were previously assessed for validity on 158 healthy men and 24 patients with confirmed Peyronie's disease. To optimize the response rate, the questionnaire was mailed three times to all the men. RESULTS: The response rate after the third mailing was 55.4% (4432 men): 142 men (3.2%, mean age 57.4 years, SD 13.4) reported the new appearance of a palpable plaque which, from the previous validation, was the most sensitive question and the main symptom of the disease. In men aged 30-39 years only 1.5% reported localized penile induration, compared with 3.0% in those 40-49 and 50-59 years, 4.0% in those 60-69 years and 6.5% of those > 70 years old. Newly occurring angulation was reported by 119 of the 142 men (84%) and painful erection by 66 (46.5%). The combination of the three symptoms (plaque, deviation and painful erection) was reported by 46 of the 4432 respondents (1.04%), i.e. 32% of the 142 men with penile induration; 58 of the 142 men (41%) reported erectile dysfunction. CONCLUSIONS: This is the first large cross-sectional, community-based study to examine the prevalence of Peyronie's disease. Using previously validated questions the prevalence of Peyronie's disease in the sample was 3.2%; this is much higher than indicated in previous reports. A comparably high prevalence is reported for diabetes and urolithiasis, suggesting that this 'rare' disease is more widespread than previously thought.     

Peyronie's disease in men under age 40: characteristics and outcome

Peyronie's disease is most commonly seen in the fifth decade of life. However, a wide range of age (20-83 y) is reported. During a 6-year period, men with Peyronie's disease presenting under the age of 40 were reviewed retrospectively and followed-up. The prevalence of Peyronie's patients presenting under age 40 was 8.2%. Their mean age was 32.47 +/- 5.37 (range: 23-39) y and 78.9% of them presented during the acute phase of the disease. Pain on erection was a part of presenting symptom complex in 52.6% and the majority (84%) had a degree of penile curvature < 60 degrees. Erectile dysfunction (ED) was present in 21% of patients, who responded well to intracavernous injection test. After a minimal 2-year follow-up, improvement in penile deformity was observed in 36.8%, and 42.1% had stable disease while 21% experienced deterioration of the penile curvature. The onset of Peyronie's disease is clinically more noisy and acute in patients presenting under age 40 and this forces the physicians to treat them more vigorously.     

Penile prosthesis implantation in the treatment of Peyronie's disease and erectile dysfunction

Although men afflicted with Peyronie's disease (PD) usually have a number of treatment options, those who also present with erectile dysfunction (ED) arising from unknown or iatrogenic causes are not easily treated. Surgical straightening procedures that have been used to treat PD may not restore erectile function and failure to straighten the penis with surgery may be the result of erectile inadequacy during the post-operative period. This paper discusses penile prosthesis implantation as a surgical option for patients with PD, placing emphasis on the choice of devices and surgical techniques. Several new techniques which hold the promise of high success rates and low morbidity are mentioned. International Journal of Impotence Research (2000) 12, Suppl 4, S122-S126.     

Peyronie's disease fibroblasts demonstrate tumorigenicity in the severe combined immunodeficient (SCID) mouse model

Peyronie's disease is a localized connective tissue disorder, caused by trauma to the erect penis, which results in cellular proliferation and excess extracellular matrix production within the tunica albuginea of the penis. We have previously demonstrated that cells derived from Peyronie's disease plaque tissue demonstrate increased cell growth, increased S-phase on flow cytometry, stabilization and inactivation of p53, and consistent morphologic transformation, all suggesting that these cells are biologically transformed. Severe combined immunodeficient (SCID) mice have been used extensively to study the pathobiology of malignant and benign tissue and cells. This study was undertaken to determine if Peyronie's derived fibroblasts had the potential to demonstrate tumorigenicity in the SCID mouse model, thus confirming their biologically transformed nature. Cultured fibroblasts were derived from three sources, namely, plaque tissue excised from men with Peyronie's disease, tunical tissue excised from young men with congenital penile curvature and neonatal foreskins. BALB/C SCID mice were divided into three groups and each group was inoculated with cultured fibroblasts from each of the three different sources. All animals were evaluated regularly and maintained in isolation for a period of 3 months following inoculation. All SCID mice inoculated with cells derived from Peyronie's disease plaque tissue (n=10) developed subcutaneous nodules at a mean time period of 2.5+/-0.5 months following injection. The mean maximum dimension and weight of the nodules at the time of killing the animal was 1.1+/-0.2 cms and 0.6+/-0.2 g, respectively. Histologically, the nodules were composed of large pleomorphic epithelioid cells with a high mitotic activity, which were negative for cytokeratin but positive for vimentin. None of the SCID mice inoculated with cells cultured from either normal tunica (n=5) or foreskin (n=5) developed subcutaneous nodules. In conclusion, the tumorigenic nature of Peyronie's disease plaque-derived fibroblasts sheds further light on the pathobiologic characteristics of these cells. Specifically, these data confirm that cells cultured from Peyronie's disease plaque are biologically transformed. Future refinement and study of this animal model may permit a more complete understanding of the pathophysiology of Peyronie's disease and fibromatoses in general. Furthermore, such an animal model may, in the future, allow a more ready evaluation of the therapeutic interventions for Peyronie's disease.     

Penile epithelioid sarcoma and the case for a histopathological diagnosis in Peyronie's disease

OBJECTIVES: To devise a set of clinical criteria that would identify which penile abnormality could be malignant and warrant biopsy, between Peyronie's disease (a pathological fibrosis involving the tunica albuginea of the penis) and epithelioid sarcoma (ES) of the penis (a rare malignant condition which can resemble Peyronie's disease in clinical presentation). PATIENTS AND METHODS: The pathology reports and histological slides of men with Peyronie's disease who underwent penile biopsy were reviewed for ES. The medical charts of suspicious cases were then reviewed by a pathologist, unaware of the origin, for consistencies in signs, symptoms and clinical findings. These consistencies were then to be used to develop criteria for biopsy. Thirty-two men underwent penile biopsy from 1992 to 2001. RESULTS: Because there were no actual cases of ES, a specific set of criteria for ES could not be established. A review of previously published cases was then used for comparison with the present patients. CONCLUSIONS: Many of the previously reported cases included signs and symptoms of urethral narrowing or compression, causing lower urinary tract symptoms. In addition, the penile nodule size was reported to progressively enlarge over time. Because of the high prevalence of Peyronie's disease and low prevalence of ES, biopsy of every penile nodule is not judicious. However, signs and symptoms of urethral obstruction, and a progressively growing and persistently painful nodule should suggest a possible malignancy and warrant biopsy.     

Penile straightening with crural graft of the corpus cavernosum

PURPOSE: We present a surgical alternative to penile straightening in Peyronie's disease that avoids penile shortening by using tissue from the crural segment of the corpora cavernosa as a graft. MATERIALS AND METHODS: We treated 7 patients with stable Peyronie's disease and satisfactory penile rigidity but significant curvature that precluded intercourse with this technique. An incision is made in the fibrous area and after stretching the gap is covered with a graft removed from the crural segment of the corpora cavernosa. RESULTS: In 6 of the 7 men straightening was satisfactory but in 1 it was not complete. No patient reported worse penile rigidity postoperatively. Donor site healing was uneventful. CONCLUSIONS: Use of tissue from the corpus cavernosum to correct penile curvature is effective. However, our results are preliminary, and long-term effectiveness and safety must be confirmed in a larger number of cases.     

Proposal: Trauma as the Cause of the Peyronie's Lesion

Purpose

We define the cause of the occurrence of Peyronie's disease.

Materials and Methods

Clinical evaluation of a large number of patients with Peyronie's disease, while taking into account the pathological and biochemical findings of the penis in patients who have been treated by surgery, has led to an understanding of the relationship of the anatomical structure of the penis to its rigidity during erection, and how the effect of the stress imposed upon those structures during intercourse is modified by the loss of compliance resulting from aging of the collagen composing those structures. Peyronie's disease occurs most frequently in middle-aged men, less frequently in older men and infrequently in younger men who have more elastic tissues. During erection, when full tumescence has occurred and the elastic tissues of the penis have reached the limit of their compliance, the strands of the septum give vertical rigidity to the penis. Bending the erect penis out of column stresses the attachment of the septal strands to the tunica albuginea.

Results

Plaques of Peyronie's disease are found where the strands of the septum are attached in the dorsal or ventral aspect of the penis. The pathological scar in the tunica albuginea of the corpora cavernosa in Peyronie's disease is characterized by excessive collagen accumulation, fibrin deposition and disordered elastic fibers in the plaque.

Conclusions

We suggest that Peyronie's disease results from repetitive microvascular injury, with fibrin deposition and trapping in the tissue space that is not adequately cleared during the normal remodeling and repair of the tear in the tunica. Fibroblast activation and proliferation, enhanced vessel permeability and generation of chemotactic factors for leukocytes are stimulated by fibrin deposited in the normal process of wound healing. However, in Peyronie's disease the lesion fails to resolve either due to an inability to clear the original stimulus or due to further deposition of fibrin subsequent to repeated trauma. Collagen is also trapped and pathological fibrosis ensues.     

Basic fibroblast growth factor expression in Peyronie's disease

PURPOSE: Peyronie's disease is a fibromatosis resulting in scarring of the tunica albuginea. While the inciting event is believed to be trauma to the erect penis, little is understood about the cascade of cellular events that leads to the formation of the plaque. Dysregulated wound healing serves as a paradigm for the study of this condition. Previous work has demonstrated a role for fibrogenic cytokines in wound healing, fibromatoses, including Peyronie's disease. We analyze the expression of the fibrogenic cytokine, basic fibroblast growth factor (FGF), by fibroblasts derived from Peyronie's disease tissue. MATERIALS AND METHODS: Patients with Peyronie's disease undergoing either penile prosthesis insertion or Nesbit penile plication surgery had biopsy specimens removed from the plaque and from normal tunical tissue remote from the plaque. Cell cultures were derived from these specimens. Cultured cells were characterized using immunofluorescence staining and immunosorbent digital imaging. The cell culture supernatants were analyzed using an enzyme-linked immunosorbent assay for the production of basic FGF. Foreskin tissue from men without Peyronie's disease was used as control cells. RESULTS: Five independent cell lines were established from plaque tissue and 4 independent cell lines were established from normal tunica from the same subjects. Intracellular antigen expression was consistent with the cells being myofibroblasts. Production of basic FGF by the plaque derived myofibroblasts was significantly greater compared to production by normal tunical myofibroblasts and foreskin fibroblasts. CONCLUSIONS: These data demonstrate the successful establishment of cell lines from plaque tissue and normal tunica from men with Peyronie's disease. The findings indicate a potential role for basic FGF over expression in the tunical fibrosis that occurs in this condition. This information may allow a better understanding of the basic mechanisms involved in the development of this disease. Furthermore, it may permit the elaboration of therapeutic strategies to prevent or reduce tunical scarring and plaque formation.     

Does the type of the Peyronie's curvature effect penile vascular parameters in normopotent men?

The aim of this study is to assess whether the type of penile curvature in normopotent men with Peyronie's disease affects the penile vascular doppler ultrasound parameters. Fifty-three normopotent patients within the stabilization phase of Peyronie's disease were evaluated retrospectively by means of color doppler ultrasonography. Bilateral cavernosal artery diameters before and after intracavernous papaverine injections, peak systolic and end diastolic velocities and the amount of leakage in the deep dorsal penile vein were compared in dorsal and ventral curvature groups of Peyronie's disease. 61% of the patients in dorsal and 59% in ventral Peyronie's curvature group have normal ultrasonographic penile vascular system. 35% and 3.3% in dorsal curvature group and 36.4% and 4.5% in ventral curvature group have venoocclusive dysfunction and mixed vascular pathologies, respectively, having no statistical correlation between them (p > 0.05). No arterial pathology was observed in any group. There was no correlation between the type of Peyronie's curvature and the penile doppler ultrasonographic findings in normopotent patients.     

Peyronie's disease: surgical management: autologous materials

Peyronie's disease in men with satisfactory erectile function but with significant penile curvature is often treated with plaque incision or excision and grafting. The advantages and disadvantages of various grafting materials have long been debated. While artificial materials have been used, the inflammatory reaction from these grafts has produced poor results. Dermal, venous and tunica vaginalis grafts require additional operative time to harvest and their quality varies. Packaged grafts of autologous materials provide a readily available, reliable and well-tolerated choice for penile reconstruction for Peyronie's disease. These grafting materials including cadavaric pericardium, mammalian intestinal serosal products and others are easily obtained and provide a resilient yet compliant graft choice that is easy to tailor and suture in place. Host reaction is minimal and the infection risk small.Results of Peyronie's plaque incision/excision and autologous grafting are presented and the surgical procedures employed are outlined. Excellent results can be expected in the hands of the experienced reconstructive surgeon.     

Penile Vascular Assessment Using Color Duplex Sonography in Men with Peyronie's Disease

Purpose

We assessed penile vasculature in men with Peyronie's disease using color duplex ultrasound.

Materials and Methods

A total of 99 consecutive men with Peyronie's disease underwent duplex ultrasound with 60 mg. intracavernous papaverine to gain an understanding of penile vasculature and its correlation to erectile rigidity. Patients were stratified into groups according to duplex ultrasound vascular parameters and the presence or absence of impotence (that is rigidity adequate for intromission).

Results

Of 97 men 31 (32 percent) complained of impotence, 8 of 99 (8 percent) had evidence of corporeal veno-occlusive dysfunction on duplex ultrasound (defined as end diastolic flow velocity greater than 4.5 cm. per second) and 43 percent had a history of vascular risk factors that may have contributed to erectile insufficiency. Impotent patients had decreased peak systolic flow velocity, increased end diastolic flow velocity and a higher percent of vascular risk factors (p = 0.0006, 0.027 and 0.0004, respectively) compared to potent patients.

Conclusions

Duplex ultrasound provides a dynamic noninvasive functional assessment of penile vasculature in Peyronie's disease. Although corporeal veno-occlusive dysfunction has been considered the primary vascular etiology of erectile dysfunction associated with Peyronie's disease, arterial insufficiency is a major contributor, which is best detected before definitive therapy.