How is Peyronie's disease diagnosed?

From the Guidelines

Peyronie's disease is diagnosed through a combination of medical history, physical examination, and sometimes imaging tests, with a careful history and physical exam of the genitalia being the minimum requirements for diagnosis. The diagnostic process should include a meticulous history of penile symptoms, including onset, precipitating factors, duration, changes over time, prior treatments used, and other conditions that may affect treatment options 1. A careful examination of the genitalia should be performed, including stretching and palpation of the flaccid penis, and documentation of circumcision status and any anomalies 1.

Some key points to consider in the diagnosis of Peyronie's disease include:

• The patient's history of penile symptoms, such as penile pain, curvature during erection, and difficulty with sexual intercourse 1
• The physical examination, which should include feeling for hardened tissue or plaques in the penis, characteristic of the condition 1
• The use of in-office intracavernosal injection (ICI) test with or without duplex Doppler ultrasound to assess penile deformity, plaque(s), and pain in the erect state 1
• The evaluation of the patient's overall condition, including any other health issues that may affect treatment options 1

The clinician should perform an in-office intracavernosal injection (ICI) test with or without duplex Doppler ultrasound prior to invasive intervention. This test enables the assessment of penile deformity, plaque(s), and pain in the erect state, and can provide additional information on the vascular integrity of the penis 1. Imaging studies, such as ultrasound, may also be used to show the location and size of scar tissue and assess blood flow in the penis 1.

It is essential to note that clinicians should evaluate and treat a man with Peyronie’s disease only when they have the experience and diagnostic tools to appropriately evaluate, counsel, and treat the condition 1. Early diagnosis is crucial, as treatment is more effective when started in the acute phase before significant scarring develops. Patients should be prepared to discuss their symptoms openly with their healthcare provider to ensure accurate diagnosis.

From the Research

Diagnosis of Peyronie's Disease

To determine Peyronie's disease, the following methods are used:

• Medical and sexual history: A detailed history is taken to understand the patient's symptoms and condition 2.
• Physical examination: A focused physical examination is conducted to assess the penile curvature and plaque formation 3.
• Imaging examinations: Various imaging modalities such as ultrasound, color Doppler ultrasound, magnetic resonance, and X-ray mammography are used to diagnose Peyronie's disease 2.

Imaging Modalities

The following imaging modalities are used to diagnose Peyronie's disease:

• Ultrasound: It is the method of choice for depicting calcifications and is safe, non-invasive, repeatable, and reliable 2.
• Color Doppler ultrasound: It is useful in diagnosing erectile dysfunction and detecting hyperperfusion around the plaques as a sign of inflammation 2.
• Magnetic resonance: It is superior to ultrasound and X-ray in detecting periplaque inflammation, but is reserved for special cases due to its high cost 2.
• X-ray mammography: It is the most accurate in showing calcifications and the angle of penile curvature, but its use is limited due to the risk of ionizing radiation 2.

Clinical Assessment

A clinical assessment is essential in diagnosing Peyronie's disease, including:

• Penile plaque palpation: To assess the size and location of the plaque 2.
• Medical history: To understand the patient's symptoms and condition 2.
• Sexual history: To assess the patient's sexual function and dysfunction 3.

Treatment

Treatment options for Peyronie's disease include:

• Medical therapy: Various medications such as verapamil, colchicine, potaba, L-carnitine, and liposomal superoxide dismutase are used to treat the disorder 3.
• Surgical therapy: Surgical procedures such as the Nesbit procedure, penile plaque incision/excision with or without grafting, and implantation of a penile prosthesis are used to treat severe cases of Peyronie's disease 4, 3.