Characterization of Septal and Punctate Scarring in Peyronie's Disease

Current and Future Directions of Technology in Assessment of Peyronie's Disease

PURPOSE OF REVIEW

This review assesses the effectiveness of various imaging modalities for diagnosing and managing Peyronie's disease (PD), exploring their clinical utility and limitations.

RECENT FINDINGS

Ultrasonography, currently the only modality endorsed by the American Urological Association, effectively detects calcifications and assesses vascular status but struggles with identifying non-palpable plaques. Computed tomography and magnetic resonance imaging provide detailed anatomical views but are costly along with other deterring factors. Autophotography and 3-dimensional imaging offer convenient home assessments but with variable accuracy. Elastography improves upon traditional ultrasonography, while emerging AI technologies show promise for automating precise curvature assessments, pending further validation. A combined approach tailored to each individual patient based on their needs enhances diagnostic accuracy. Supplementing ultrasonography with elastography and potentially AI could improve diagnostic outcomes and better guide treatment decisions. Continued research is vital to integrate these advancements into standard clinical practice and develop updated standardized protocols.

Review of the role of imaging in the diagnosis of priapism

Imaging has a specific role in the diagnosis and management of priapism. The primary imaging modality is ultrasound with colour Doppler (CDUS) which can accurately assess the hemodynamics of the cavernosal arteries. This is particularly useful in equivocal cases and can help differentiate ischemic from non-ischemic priapism as well as confirm the presence and location of arterio-venous fistulae post penile trauma. Furthermore, CDUS is invaluable in the post treatment follow up of non-ischemic priapism. Contrast enhanced magnetic resonance imaging (MRI) can demonstrate the extent of cavernosal necrosis in ischemic priapism and in conjunction with computer tomography (CT) has an important role in excluding underlying malignancy. MRI and CT angiography are used to evaluate pudendal arterial anatomy, which can be extremely variable and aids in the management of non-ischemic priapism. In selected cases of non-ischemic priapism, catheter angiography and transcatheter embolization of arteriovenous fistulae is an effective treatment. This review will examine the specific roles of different imaging modalities in the subtypes of priapism as well as highlight some of the pitfalls encountered in imaging.

Management of Patients With Normal Physical Exams and Ultrasound Evidence of Isolated Septal and Punctate Penile Scarring

Introduction

Atypical penile tunical lesions including isolated septal (ISS) and punctate scarring (PS) are an under recognized and difficult to treat subset of Peyronie's disease (PD) that often present with normal physical exams. Current guidelines provide little direction in the treatment of these men.

Aim

To review the results of our treatment approach in men with ISS and PS.

Methods

Data from all men undergoing duplex ultrasonography for either Peyronie's disease and/or erectile dysfunction over a 3-year period were reviewed. All men with ISS or PS and normal physical exams were included. First- and second-line treatment preferences and satisfaction with treatment in men with ISS and PS were retrospectively reviewed. Logistic regression was used to investigate associations between scar features and treatment preference

Main Outcome Measures

Treatment preference patterns, treatment satisfaction.

Results

A total of 217 men with ISS and 197 men with PS were identified. Of these, 71 ISS and 86 PS patients had normal physical exams. Majority of men in both ISS (70.4%) and PS (81.4%) cohorts initially opted for non-invasive management through either observation, oral therapy, or traction therapy. After initial management 84.5% of ISS and 93% of PS patients were satisfied with their results. A significant trend toward inflatable prostheses as second line therapy was seen in men with PS.

Conclusions

There is a mounting need for clinical guidance in order to best manage men with atypical PD in the absence of societal guidelines and high-quality studies. This series provides guidance to clinicians on the management of these men, suggesting that conservative therapy and education may be sufficient. A standardized approach of increasing invasiveness showed reasonable rates of satisfaction with minimally invasive therapies playing a prominent role. Stern N, Punjani N, Brock G, Management of Patients With Normal Physical Exams and Ultrasound Evidence of Isolated Septal and Punctate Penile Scarring. Sex Med 2021;9:100346

Diagnostic utility of penile ultrasound in Peyronie's disease

PURPOSE

To review the literature regarding the use of penile ultrasound in the evaluation and management of Peyronie's disease.

METHODS

A literature review was performed using PubMed from 1980 to 2018 using the keywords: Peyronie's disease, ultrasound, sonography, calcification, penile fracture, and penile hematoma. Articles were reviewed for study size, image protocols, and findings. In addition, we reviewed images from 227 penile ultrasounds performed on Peyronie's disease patients at the Walter Reed National Military Medical Center between 2014 and 2018.

RESULTS

Through extensive urological and radiographic literature review over the last four decades, common patterns and characteristic of Peyronie's plaques were identified. These characteristics are not always delineated by physical examination alone. The ultrasound images often added objective information including etiology of erectile dysfunction and location or plaques, and presence of calcifications which aid in patient counseling and treatment protocols.

CONCLUSIONS

The use of B-mode ultrasound with color Doppler in the evaluation and management of Peyronie's disease is a quick, cost-effective process that provides objective information that can assist the urologist in the treatment of patients with Peyronie's disease.