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Author Topic: Why you should have an ultrasound to diagnose your Peyronies Disease - ESSM article, Aug 2019  (Read 766 times)

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Pfract

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Utility of doppler ultrasound in Peyronie’s disease

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The use of ultrasound in the diagnosis of Peyronie’s disease (Peyronies Disease) was first described by Alteffar and Jordan in a paper published in 1981. They concluded that this technique was useful to demonstrate the plaque itself and its calficication, allowing to identify those patients who will benefit from a medical or surgical treatment.

But it was not until 1991, when Lopez and Jarow described the utility of the duplex ultrasound in the assessment of Peyronies Disease patients. They found evidence of arterial disease in 27 % of the so called “impotent” patients and plaque in only 39 % of the whole group.

Since then, ultrasound has been used in men with Peyronies Disease to localize lesions, follow plaque size, and perform Doppler vascular studies. Among men who are diagnosed with Peyronies Disease but do not have palpable plaques, penile ultrasound is often demonstrative of septal fibrosis, intracavernosal fibrosis, or sub-tunical calcifications. Studies have evaluated the prevalence of calcification in chronic Peyronies Disease and used the presence of calcified plaques as an exclusion criterion for studies of medical treatment of Peyronies Disease.
The current guidelines recommendations

However, nowadays, for the main clinical practice guidelines the duplex ultrasound does not appear to be particularly relevant or to play a significant role in the diagnostic evaluation of patients with Peyronies Disease.

Thereby, the EAU Guidelines on Erectile Dysfunction, Premature Ejaculation, Penile Curvature and Priapism, in the 2019 edition, stablish that “ultrasound measurement of the plaque’s size is inaccurate and operator dependent” (level of evidence -LE- 3), and that “doppler ultrasound is required to ascertain vascular parameters associated with Erectile Dysfunction (LE 2a). They recommend not to use ultrasound measurement of plaque size in everyday clinical practice (weak). The AUA Guidelines on Peyronies Disease, 2015 version, give an expert opinion recommedation in this situation, in which “clinicians should perform an in-office intracavernosal injection test prior to invasive intervention, with or without duplex doppler Ultrasound”.

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In conclusion

Better description of plaque’s characteristics, specially the degree of
calcification, seems to be of great importance to understand the potential development of the disease and to optimize and personalize the subsequent treatment. The recent introduction of CCH as a conservative therapy for this disease strenghthens this statement. Besides, knowing the vascular status of the penis with Peyronies Disease may help to counseal adequately the patient in the best surgical approach to avoid complications.

Doppler ultrasound is a relatively low-cost and minimally invasive technique can quickly and efficiently identify these factors. So, for the authors, there are sufficient reasons to routinely perform a doppler ultrasound of the penis in the assessment of patients with Peyronies Disease, at least before planning the better treatment to receive.


https://www.essm.org/utility-of-doppler-ultrasound-in-peyronies-disease/

With so many debates here on "should i have an ultrasound to know if i have Peyronies Disease or not?" "should it be flaccid or erect?" I came across this today as i was searching for something else, and i thought it was an excellent read, to share and give it as a good reference to others that may be unsure of what path to follow.

Comments would be greatly appreciated.

TonySa

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Yes, it supports an erection is only necessary if ALSO assessing vascularization to diagnose Erectile Dysfunction (for Peyronie’s diagnosis flaccid is sufficient);

“when combined with an intracavernous injection of an erectogenic medication (e.g. alprostadil), doppler ultrasound may be used to assess penile vascularization along with a direct inspection of the penile malformation (Kelami test).”
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PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

diehardpatriot

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It doesn’t detect everything though. Ultrasound didn’t catch the lump in my penis. Maybe that’s a good thing though? Who knows.
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Penis injury in late 2017. A lump formed at injury site that caused no deformity, just pain and a palpable lump. Pain is improving through proper rest and use, diet, and mindfulness. I am always learning and looking to share things that have helped.

TonySa

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I’ve heard of plaque being missed w ultrasound, I wonder if that’s based on the doctors experience?
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PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

diehardpatriot

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In my case it was Dr Levine in Chicago. He’s a veteran. I just think that there’s no perfect screening method
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Penis injury in late 2017. A lump formed at injury site that caused no deformity, just pain and a palpable lump. Pain is improving through proper rest and use, diet, and mindfulness. I am always learning and looking to share things that have helped.
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