What is circumferential plaque?!

[TWalker]

I've read this phrase in papers a million times- 'Plaque location can be dorsal, ventral, lateral, circumferential or septal.' And I always assumed that circumferential meant it wraps all the way around the penis but read elsewhere that it just means the plaque is located horizontally rather than vertically... Does anyone know what circumferential plaque means?

I have hourglassing with a palpable plaque on each side of the penis, opposite each other, both causing an indentation... There is a 'valley' linking the two areas of indentation across the top of the penis but I cannot feel any plaque between them at all... do I have a plaque wrapping all the way round my penis at one point that I just cannot feel or is it more likely they're two separate areas of Peyronies and the indentation in the middle is just the combined effect of both of these separate plaques?

In other words, is the palpable 'nodule' the extent of the Peyronie's plaque or is it just the tip of the iceberg with a far more extensive area of scarring below it?

Anyone got a clue? I'm a bit lost!

-TW

[Hawk]

It simply means plaque tending to follow the circumference than the length of the shaft.  It is not different or a sub-type.  It can start to encircle the penis and go 1/3 of the way around then go lengthwise.

Plaque seldom develops depth because it replaces the elastin in the tunica.  The tunica is not a thick structure.

It is possible to get scarring or fibrosis in the corpora cavernosa but that is not "typical" Peyronies Disease.

[TWalker]

Thanks so much for clarifying Hawk!

So sounds like it's unlikely the tip of the iceberg in terms of depth but how about in terms of area? Is the area of plaque often far more extensive than the palpable nodule (the nodule just being the most defined bit and thus the only bit palpable) OR if I feel a nodule on each side of the penis but nothing across the middle linking them am I unlikely to have one big plaque that goes all the way across the middle? (Even though there is a bit of a depression there)

Additionally, can a small pea sized plaque effect a far greater area than where it is- e.g. a 0.4cm plaque causing a circumferential indentation that is 2.5cm long)?

-TW

[TWalker]

Any thoughts on the above questions Hawk? (or anyone else!) I know they're quite complex to answer.

[Hawk]

Plaque is simply scar tissue replacing elastin (stretchy tissue).  It is like a piece of tape on a balloon that bends the balloon when you blow it up.  To be exact is more like replacing a piece of the actual balloon with a piece of tape because the scar tissue is not on the tunica.  It replaces tunica tissue.  How thick the scar or tape is is an academic conversation that means nothing as far as deformity is concerned.

I nor no one else can answer your questions.  Those questions have no bearing on treatment.  Only a good doctor with a Doppler Ultrasound or someone disecting your penis could begin to answer those questions.  From a practical standpoint, you only have to know that you have scarring that is not from a major injury.  It is causing deformity.  It requires very accurate size monitoring and treatment.

I will leave it to others to speculate, conduct scientific research, and have academic conversations.

[TWalker]

Thanks Hawk, understand that they're difficult questions to answer but seems bizarre to me that I cannot find an answer to these questions online or in any of the hundreds of studies I've read. Surely there's urologists out there who have felt enough nodules and conducted enough ultrasounds to conclude whether the palpable nodule is approximately the same width as the scarred area of the tunica or whether the scarred tunica area is actually much larger than the palpable nodule... I'm astounded I can't find an answer to this anywhere.

Thanks for the suggestion but don't think I'll go for the penis dissection option... maybe during my post-mortem but hopefully that's a good few years away!

I have however done as you advise and visited a top urologist who confirmed my condition as Peyronies Disease due to palpable plaques and deformity. Also had a Doppler Ultrasound by a radiologist specialising in andrology... unfortunately this was rather equivocal and even when he meticulously scanned over the largest, most palpable plaque, nothing at all showed up on the ultrasound- seemed odd to me but perhaps my scarring is so new (few months since injury) that it does not yet show up... or perhaps this is common and there's another explanation?

Respect that you don't want to speculate Hawk, however if anyone else does please feel free to have your best guess as to the answer to any of my questions! Dr Google has let me down thus far...

[Hawk]

I don't think you are grasping my explanations.  There is not plaque and nodules and scar tissue, and fibrosis.  It is all the same thing.  These are nothing but different terms like creek, stream, brook, run.

I have no idea what you are trying to accomplish by obsessing over semantics, but it is not a productive use of your time.

[TWalker]

My fault for mixing the terms... well aware that they all refer to the same thing though my mixing of the terms may have given the impression I'm not aware of this. To rephrase- my core question is... Is the palpable plaque the same size as the actual plaque or is it likely the plaque is MUCH wider (but not deeper) and I'm not able to palpate it's full extent.

Not obsessed by semantics at all though it may have come across that way- the thing I AM obsessed with is trying my absolute best to figure out exactly what the idiosyncratic features of my condition are and thus the best ways to treat it so it does not greatly impair my sexual ability for the rest of my life! (though of course treatments will be relatively similar regardless of these answers- but I may be more of less aggressive or tailor them differently depending on the extent of my plaque).

Ultimately, I, like many others, am beyond devastated by it and am left feeling powerless and frustrated that there's not a huge amount I can do to prevent what seems like the arbitrary destructive process of the disease. So fruitless or not, the  only thing that gives me any sense of agency over it is to research as much as possible and be confident I know as much as is possible about what I've got and that I am employing the best possible interventions to limit its damage. Unfortunately my hourglassing/indentations/beginnings of hinging seem to be a particularly difficult subset to treat and have a concerning rate of progression to surgery (which I know many members such as yourself have achieved great success with but is something I'm desperate to avoid at my young age!)

Fingers crossed all my mental energy equates to improved intervention choices and outcome but even if it doesn't, overly researching and obsessing about getting to the bottom of my condition gives me some semblance of power over the disease and is healthier than being in fetal position and having a panic attack!

-TW