New York--Routine ultrasound assessment of the flaccid penis in patients with Peyronie's disease gives otherwise unobtainable clinical evidence that is useful in treatment, according to results of a large study from the University of California, San Francisco.
"To date, this is the largest cohort of patients in whom this has been examined," Lt. Col. Robert C. Dean, MD, told attendees at the Sexual Medicine Society of North America annual meeting here.
There were 570 participants in the study, and an ultrasound examination produced results differing from those of standard diagnostic procedures in 44% of those cases.
"Ultrasound can be quite beneficial and quite consistent" in diagnosis of Peyronie's disease, Dr. Dean said, noting that the value lies in "what you do with the information."
Dr. Dean's report met with some skepticism at the meeting.
"Ultrasound on the flaccid penis has limited utility in the setting of Peyronie's disease," said Nelson Bennett, Jr, MD, a fellow in sexual medicine at Memorial Sloan-Kettering Cancer Center, New York. "The detection of subclinical plaques is most likely unimportant in the sexual satisfaction of men and their partners."
Dr. Dean acknowledged that an ultrasound scan should be only one part of the examination.
"Many patients should have a hemodynamic study as well," he said.
But ultrasound examination of the flaccid penis was productive in the current study, with 24% of the images showing plaques that were not evident on palpation.
More informed treatment choices
The study began in 2000, with high-frequency ultrasound (7.5 MHz) added to the standard diagnostic procedures-detailed history and physical examination-for every patient presenting with a complaint of penile pain and/or curvature. The most common complaint was dorsal curvature, seen in 266 of the patients.
Abnormal ultrasound images were seen in 280 patients, with the abnormalities always corresponding with Peyronie's plaques. Calcification was found in the flaccid penis of 178 patients. Very dense hyperechoic lesions with acoustic shadowing corresponded with calcified mature plaques.
"Differentiating between mature calcified plaques versus early disease fibrosis can lead to better treatment choice for the individual patient," Dr. Dean said.
The ultrasound images also showed septal defects in 72 patients that were not detectable by palpation.
"Penile palpation in combination with ultrasound provides a better understanding of the disease process for each patient," he said. "Ultrasound can suggest severity and maturity of disease, which cannot be gathered by history and physical examination alone."
The study's findings "challenge or affect our current clinical practices," Dr. Dean added, explaining how his own practice has changed as a result.
"We do ultrasound routinely, because in a quarter of our patients, we have a different view of their disease after an ultrasound examination," he said.
One effect of the data provided by that examination is to have some patients move faster to surgery, according to Dr. Dean.