Diagnosis of
Peyronie's Disease
Diagnosis entails defining the lesion and distinguishing between the acute and chronic phases of the disease, as treatment approaches significantly differ between these phases.
The assessment of the injury can be achieved through self-photography of the erect penis by the patient or through evaluation in the doctor’s office by inducing a pharmacologically induced erection. Pharmacologically induced erection is achieved through the painless injection of vasoactive substances into the penis, which relax muscle fibers and increase blood flow, resulting in an erection. During this process, a special assessment of erectile function is conducted using penile triplex. Penile triplex is a sophisticated test to examine the integrity of the arterial supply to the penis, as well as the venous outflow.
It is crucial during pharmacologically induced erection to accurately determine the degree of angulation and monitor any changes through monthly measurements of the bending angle using a specialized instrument called the Peyronie’s Disease Assessment Device (PDAD).
In the second stage, the phase of the condition is determined. The acute phase is characterized by pain during erection and palpable hardness in some part of the penis, usually on the upper surface.
Penile ultrasound is utilized to identify thickening or plaque and assess the extent of calcification.
Understanding the two phases requires an exploration of the pathophysiology of the condition.
- Acute Phase
Let’s consider a scenario where a penetration injury occurs. During the injury, the fibrous sheath surrounding the corpora cavernosa (tunica albuginea) may experience a partial rupture.
If the rupture is complete, it will manifest as a large hematoma and severe pain, characteristic of a penile fracture that necessitates immediate emergency surgical treatment. If the rupture is incomplete, a healing process starts. Sometimes healing is not possible and the process leads to the development of scar tissue.
Typically, when tissue is damaged, the body responds to this injury in a nonspecific manner by invoking the generic inflammatory response reaction. Intervention is needed at this point to avoid the formation of larger plaque (larger scar),, as well as the calcification of the plaque.
- Chronic Phase
If the lesion is left untreated, it will gradually expand over time, leading to calcification of the damaged tissue.
At this point, the disease progresses into the chronic phase, characterized by the stabilization of the plaque with no further changes.
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