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Year : 2005  |  Volume : 15  |  Issue : 3  |  Page : 355-356
Peyronies disease - a case report


Department of Radiology, Jaslok Hospital and Research Center, Mumbai, India

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Keywords: Peyronies Disease - Sonography

How to cite this article:
Halankar J A, Hegde A N, Shah S M. Peyronies disease - a case report. Indian J Radiol Imaging 2005;15:355-6

How to cite this URL:
Halankar J A, Hegde A N, Shah S M. Peyronies disease - a case report. Indian J Radiol Imaging [serial online] 2005 [cited 2020 May 31];15:355-6. Available from: http://www.ijri.org/text.asp?2005/15/3/355/29155

   Introduction Top


Francois de la Peyronie described Peyronies disease also known as plastic induration of the penis and penile fibromatosis in 1743. Erectile dysfunction that in most patients precedes the disease itself and posttraumatic painful erection are important features of the disease

It is characterized by deposition of fibrous or even calcified plaques within the corpora cavernosa or on the tunica albuginea causing functional shortening and curvature of the involved aspect of the corporal body during erection. We report a case of Peyronies Disease detected on gray scale and colour flow imaging.

A forty six year old married gentleman, a father of ten children presented to us on out patient department [OPD] basis with complaints of erectile dysfunction since a longstanding period of four to five years. Patient gives a history of a highly active sex life for a period of two decades prior to the complaint however no history of trauma was elicited. Patient was also a chronic smoker however a non-diabetic. On physical examination hard plaque like lesions were palpable in both corpora cavernosa bilaterally on the entire dorsal aspect.

We performed a Ultrasound and penile colour Doppler study using a high frequency L 12-5 probe of an ATL machine, the HDI 3500.Ultrasound gray scale imaging showed multiple calcified plaques in the soft tissue of the corpora cavernosa and corpora spongiosum more marked dorsally. A few calcified plaques were also seen in the cavernosal arteries.

Pre injection study in a flaccid state revealed normal colour flow in the cavernosal arteries. Penile Colour Doppler was performed by injecting thirty mg of papavarine in the corpora cavernosa using a thin twenty-six number needle. The patient was then left in privacy after being asked to stimulate himself manually to achieve optimal tumescence. Multiple ultrasound examinations were

performed at regular intervals of 2, 5, 10, 15, 20, 25, and 35 minutes of bilateral corpora cavernosal arteries and serial spectral waveforms were obtained. Scan performed up to thirty-five minutes revealed good Peak Systolic Velocities [PSV] in left cavernosal arteries with no significant diastolic flow. Sub optimal maximum Peak Systolic Velocity [PSV] of 22cm/second was seen in the right cavernosal artery suggestive of arterial insufficiency. Persistent diastolic flow was noted in the right cavernosal artery through out the study. Clinically the patient developed inadequate tumescence.

With the given history of erectile dysfunction along with imaging findings of calcified plaques in bilateral corpora cavernosa and sub optimal flow in the right cavernosal artery we came to a diagnosis of Peyronies Disease with arterial insufficiency.


   Discussion Top


A lesion in the tunica albuginea of the corpora cavernosa characterizes Peyronies disease. During erection this lesion causes functional shortening and curvature of the involved aspect of the corporal body. This lesion has commonly been called a plaque. Peyronies disease is seen in 1% of the white men and there is a clear predominance between the ages of 45 and 60 yrs. Approximately 30% of the patients have associated Dupuytren's contracture. A familial association is noted in patients with these conditions. Evidence indicates that the inciting event in Peyronies disease is trauma. Acquired curvature of the penis inevitably follows trauma. Patients who have had vigorous internal urethrotomy occasionally develop significant curvature. Trauma combined with intravasation of blood leads to inflammation, induration and eventual scarring. [1]

Two presentations of Peyronies disease are commonly seen. In many patients the onset of Peyronies disease is insidious. These men have lost much of their turgor of erection. These patients notice pain or a painful lump in the penis, followed by minimal curvature that may slowly progress. In contrast, about half of the author's patients notice that the condition appears suddenly with little or no further progression. [2]

Sexual dysfunction in Peyronies Disease may be caused by pain, deformity, erectile dysfunction or a combination of these. In those patients with a significant stable deformity and/or erectile dysfunction, surgery may be appropriate in the management of the disease, the aim of the surgery being the restoration of the ability to achieve penetrative intercourse. The reported prevalence of impotence among men with Peyronies disease ranges from 4% to 40% and may be organic or psychological in origin. Its presence may influence the surgical approach to the problem. It has been reported that where erectile dysfunction is adequate, surgery to correct the deformity in such patients is likely to be successful. In recent years, colour Doppler imaging [CDI] has contributed to the understanding of vascular dysfunction in Peyronies disease and it has been suggested that this information is crucial before deciding to use Nesbit's procedure. [3]

In a study by Levine and Coogan to evaluate patients with Peyronies disease all patients underwent a duplex ultrasound penile colour flow study after intracavernous injection of sixty milligrams of papavarine with a twenty-seven-gauge needle. A rubber band was placed around the base of the penis and removed after three minutes. Ultrasound was performed using grey scale imaging and Doppler unit with real-time spectrum analysis. Haemodynamic measurements were obtained three to five minutes after injection and again after self-manual and visual stimulation in privacy to induce maximum erection. This second set of measurements was obtained twenty to twenty-five minutes after injection [corresponding to the rigid erection phase]. Recorded parameters included Peak Systolic Flow Velocities [PSV], End Diastolic Flow Velocities [EDV] and Resistance index [PSV-EDV/PSV]. Measurements were recorded for the right and left cavernous arteries. [4]

A series of 50 patients was studied by Montorsi et al using grey scale and colour Doppler imaging showed that the area of scar tissue within the cavernous bodies were accurately detected and mapped by high resolution ultrasonography in 43 cases [86% percent], while in 7 [14%] no echo graphic abnormality was found at the site of the palpable plaque. Plaques were identified as hyperechoic areas that caused shadowing of the underlying corporeal tissue. Colour flow mapping revealed involvement of the deep dorsal vein within the plaque in 20 patients [40% percent]. Cavernous artery inflow was considered insufficient when peak flow velocities and blood flow volume values of less than 25cm/sec and 10 ml/min respectively. Corporal veno-occlusive dysfunction was diagnosed when cavernous artery end diastolic velocities at 15 to 30 minutes were greater than 10cm/sec and resistance index in these settings was less than 0.75. [5]

Abnormalities of cavernous artery inflow and corporeal veno-occlusive mechanism are observed in a large percentage of patients with Peyronies disease if an accurate and specific diagnostic device is used.

One study demonstrated that a history of erectile dysfunction associated with Peyronies disease correlated well with Doppler sonography. However some patients complained of slight or mild impotence, and in these cases colour Doppler sonography could precisely detect the minimal abnormality of penile vascular function. This documentation of erectile function could safely guide the therapeutic choice. [6]

 
   References Top

1.Campbell ES. Et al Campbells Urology 7th Edition: 2000  Back to cited text no. 1    
2.Campbell ES. Et al Campbells Urology 7th Edition: 2000  Back to cited text no. 2    
3.Ahmed M, Chilton CP, Munson KW, Williams JH, Pallan JH, Turner G. The role of colour Doppler imaging in the management of Peyronies Disease. Br J Urol. 1998 Apr;81(4):604-6.  Back to cited text no. 3    
4.Levine LA, Coogan CL. Penile vascular assessment using color Duplex sonography in men With Peyronies disease. J Urol. 1996 Aprl;155(4):1270-3.  Back to cited text no. 4    
5.Montorsi F, Guazzoni G, Bergamaschi F, Consonni P, Rigatti P, Pizzini G, Miani A. Vascular abnormalities in Peyronies disease: the role of color Doppler sonography.J Urol. 1994 Feb;151(2):373-5.  Back to cited text no. 5    
6.Montorsi F, Guazzoni G, Bergamaschi F, Consonni P, Rigatti P, Pizzini G, Miani A. Vascular abnormalities in Peyronies disease: the role of color Doppler sonography. J Urol. 1994 Feb;151(2):373-5.  Back to cited text no. 6    

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Correspondence Address:
S M Shah
Consultant and coordinator, Ultrasound Department, Jaslok Hospital and Research center, Mumbai - 400026
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.29155

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[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

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