Ultrasound is useful for the identification of lesions and to determine their relationship with the neurovascular bundle. Individuals with Peyronies disease can present with erectile dysfunction, often related to venous leakage, due to insufficient drainage at the site of the plaque. Although plaques are more common on the dorsum of the penis, they can also be seen on the ventral face, lateral face, or septum. Treatment
Medication and supplements
Many oral treatments have been studied but results so far have been mixed. Some consider the use of nonsurgical approaches to be controversial.Vitamin E supplementation has been studied for decades, and some success has been reported in older trials; those successes have not been reliably repeated in larger, newer studies. The use of Interferon-alpha-2b in the early stages of the disease has been studied; as of 2007, its efficacy was questionable.Collagenase clostridium histolyticum is reported to help by breaking down the excess collagen in the penis. It was approved for treatment of Peyronies disease by the FDA in 2013. Physical therapy and devices
There is moderate evidence that penile traction therapy is a well-tolerated, minimally invasive treatment; there is uncertainty about the optimal duration of stretching per day and per course of treatment, and the treatment course is difficult. Focused shockwave therapy
Focused extracorporeal shockwave therapy is a non-invasive treatment option that involves passing acoustic pulses through the plaque, which can break it down over a series of six to twelve sessions. The treatment is most effective in men with mild to moderate Peyronies.
It can affect men of any race and age. Psychosocial
Peyronies disease can also have psychological effects. While most men will continue to be able to have sexual relations, they are likely to experience some degree of erectile dysfunction. It is not uncommon to exhibit depression or withdrawal from their sexual partners. Causes
The underlying cause of Peyronies disease is unknown. Although, it is likely due to a buildup of plaque inside the penis due to repeated mild sexual trauma or injury during sexual intercourse or physical activity.Risk factors include diabetes mellitus, Dupuytrens contracture, plantar fibromatosis, penile trauma, smoking, excessive alcohol consumption, genetic predisposition, and European heritage. Diagnosis
A urologist may be able to diagnose the disease and suggest treatment. An ultrasound can provide conclusive evidence of Peyronies disease, ruling out congenital curvature or other disorders. Ultrasonography
On penile ultrasonography, the typical appearance is hyperechoic focal thickening of the tunica albuginea. Due to associated calcifications, the imaging of patients with Peyronies disease shows acoustic shadowing, as illustrated in figures below. Less common findings, attributed to earlier stages of the disease (still mild fibrosis), are hypoechoic lesions with focal thickening of the paracavernous tissues, echoic focal thickening of the tunica without posterior acoustic shadowing, retractile isoechoic lesions with posterior attenuation of the beam, and focal loss of the continuity of the tunica albuginea. In the Doppler study, increased flow around the plaques can suggest inflammatory activity and the absence of flow can suggest disease stability.