Peyronie disease is the most common cause of painful penile induration. Fibrous tissue plaques form within the tunica albuginea, causing painful deformity and shortening of the penis. Though clinical diagnosis is usually accurate, the role of imaging is to evaluate extension of plaques, whether the penile septum is involved, and to examine the relationship between the plaques and the penile vasculature.
Symptomatic Peyronie disease incidence has been estimated at ~1% of erectile dysfunction cases 2, but the incidence has been rising due to increasing use of pharmacologic treatment for erectile dysfunction. Its age of onset is around 50-60 years of age.
- penile trauma
- diabetes mellitus
- beta-blocker use
- Paget disease of bone
- phenytoin use
- curved/bent penis*
- penile plaque
- decreased penile length
- less rigidity of penis
- penile numbness
- erectile dysfunction
- painful erection
* congenital curvature of penis is a different condition, seen in children and young adults, and does not cause any problem
During pharmacologically induced erection, Peyronie plaques are identified as localised/diffuse thickening of tunica albuginea. Echogenic plaques are usually seen on the dorsal aspect of the penis, however they may also be seen on the ventral aspect. Calcifications are also frequently seen on sonography.
Ultrasound can detect the relationship of plaques and surrounding structures. For instance, involvement of the neurovascular bundle is important, which can be seen as plaque embedded within the dorsal arteries. Cavernosal artery encasement is seen in cases of septal plaques. This arterial encasement can lead to erectile dysfunction (arteriogenic).
Plaques appear as thickened and hypointense signal areas on T1 and T2 weighted images, in and around tunica albuginea. They are usually best seen on T2 weighted images 1 . Albugineal calcifications are difficult to recognize on MRI.
Contrast enhancement may or may not be seen in active inflammation. The utility of contrast enhancement for diagnosis is controversial 1 .
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.
History and etymology
It is named after François Gigot de Peyronie, a French surgeon who described the condition in 1743.
- sclerosing lymphangitis of penis: a superficial 'rope-like' lesion usually located at coronal sulcus, and on examination, seen as a thrombosed vein
- congenital curvature of penis
- 1. Bertolotto M, Pavlica P, Serafini G et-al. Painful penile induration: imaging findings and management. Radiographics. 29 (2): 477-93. doi:10.1148/rg.292085117 - Pubmed citation
- 2. Hakim LS. Peyronie's disease: an update. The role of diagnostics. Int. J. Impot. Res. 2002;14 (5): 321-3. doi:10.1038/sj.ijir.3900871 - Pubmed citation
- 3. Prando D. New sonographic aspects of peyronie disease. J Ultrasound Med. 2009;28 (2): 217-32. Pubmed citation