How is Peyronie's disease diagnosed?

Diagnosis of Peyronie's Disease

Peyronie's disease should be diagnosed through a careful history to assess penile deformity, interference with intercourse, penile pain, and/or distress, along with a physical examination of the genitalia to evaluate for palpable abnormalities of the penis. 1

Essential Diagnostic Components

Medical History Assessment

• Obtain a detailed history of penile symptoms including onset, precipitating factors, duration, changes over time, prior treatments, and other conditions (e.g., erectile dysfunction) that may affect treatment options 1
• Document penile deformity characteristics, interference with intercourse, presence of pain, and psychological distress 1
• Determine disease phase (active vs. stable) as this affects treatment approach 1
• Assess for history of penile trauma during intercourse, which is often associated with symptom onset 1, 2

Physical Examination

• Perform careful examination of the genitalia including stretching and palpation of the flaccid penis 1
• Document circumcision status and any penile anomalies (e.g., hypospadias) 1
• Palpate for penile plaques or areas of induration, which are characteristic findings 1, 3
• Note that in early disease, plaques may not be palpable in the non-erect state 1

Advanced Diagnostic Testing

Intracavernosal Injection (ICI) Test

• Perform an in-office intracavernosal injection test prior to any invasive intervention 1
• This enables assessment of penile deformity, plaque(s), and pain in the erect state 1
• When combined with duplex Doppler ultrasound, additional measurements can be made:
  • Plaque size and/or density 1
  • Differentiation between calcified and non-calcified plaques 1
  • Assessment of vascular integrity of the penis 1

Disease Characterization

Active Disease

• Characterized by dynamic and changing symptoms 1
• Penile and/or glanular pain or discomfort with or without erection is the defining symptom 1
• Plaque(s) and penile deformities may not be fully developed at this stage 1
• Erectile function may be intact or compromised by pain and/or developing deformity 1

Stable Disease

• Symptoms clinically unchanged for at least three months 1
• Pain with or without erection may rarely be present but is typically mild 1
• Curvature may be uniplanar or biplanar 1
• Plaque(s) may be palpable or apparent on ultrasound 1
• Typical presentation includes dorsal, dorso-lateral, or ventral penile deformity 1

Common Pitfalls and Considerations

• Ensure proper specialist involvement - clinicians should evaluate and treat Peyronie's disease only when they have the experience and diagnostic tools to appropriately evaluate, counsel, and treat the condition 1
• Distinguish Peyronie's disease from other conditions that may cause penile deformity, such as penile tumors 1
• Recognize the psychological impact - many men experience emotional distress, depressive symptoms, and relationship difficulties 1, 4
• Be aware that patients may be hesitant to discuss symptoms unless directly asked and may not know that treatments exist 3
• Understand that incidental diagnosis is common, with reported rates as high as 16% during routine or unrelated healthcare visits 3
• Remember that the disease can significantly impact quality of life and sexual function, causing anxiety in sexual situations and decreased sexual confidence 1, 4

By following this diagnostic approach, clinicians can properly identify Peyronie's disease and determine the appropriate phase of the condition, which is crucial for guiding treatment decisions.