Algorithm for diagnosing Peyronie’s disease (fibroplastic penile induration):
- — evaluation of the patient’s history and complaints;
- — physical examination;
- — laboratory methods of examination;
- — instrumental methods of examination:
- — Ultrasound of the penis and its vessels with artificially induced erection (more informative) or without;
- — MRI or CT of the penis with artificially induced erection (more informative) or without);
- — patient survey:
- — evaluation of the erection hardness scale (EHS);
- — international index of erectile function and other tests.
In the vast majority of cases, the correct diagnosis is possible only on the basis of a thoroughly collected history, patient complaints and physical examination (palpation) of the patient’s penis.
The main purpose of the diagnosing of the patient – to obtain reliable information about the symptoms of the disorder (pain with and without erection and/or sexual intercourse, palpable nodules, erectile deformation), their severity (the degree of erectile deformation, measured in degrees*) and duration; penis length during erection, as well as the state of erectile function (quality of sexual life, rigidity (stiffness) of the penis).
* For more information on how to properly measure the angle of curvature of the penis, see HERE.
The most frequent (and main) complaints in patients with fibroplastic penile induration are:
— presence of palpable plaque (plaques) in the tunica albuginea of the penis (according to some studies, the plaques in the tunica albuginea of the penis in Peyronie’s disease are palpated in 70% of cases);
— pain or discomfort during erection and/or sex;
— penile curvature during erection**.
** Erectile dysfunction is the most common and one of the most important symptoms of disorder. It is the degree of penile curvature during erection which is the main criterion in choosing a method of treatment, as well as the main reason why a patient with fibroplastic penile induration experiences worsening of sexual life.
Plaques in the tunica albuginea are sometimes painless; sometimes the pain can disappear unassisted after a few months from the onset of fibroplastic penile induration.
Physical examination is the main stage of diagnosis, which consists in visual examination of the penis both at rest and in the state of erection. Examination and palpation of the penis is performed, the size, localization and number of plaques in the tunica albuginea are estimated. Examination of the penis during erection allows assessing the degree of erectile deformation and rigidity (stiffness) of cavernous bodies. Plaque density (soft, dense, bone density) is also estimated, which helps to estimate the degree of its calcification, which directly affects the tactics of treatment of Peyronie’s disease in the future. Fully calcified plaques are often difficult to treat by conservative treatment and usually require surgical treatment.
Plaques in fibroplastic penile induration can be palpated both in a relaxed state of the penis and in erection. In this case, it is in the state of erection that it is possible to determine which plaque causes erectile deformation and is crucial in worsening the quality of sexual life of a patient with Peyronie’s disease (if there are several plaques).
If necessary, instrumental methods of diagnosing (ultrasound, MRI, CT, radiography, etc.) can be used to assess the degree of calcification.
Full and correct diagnosis for fibroplastic penile induration must reflect the stage of the illness (acute or chronic), type of erectile deformation, and the degree of curvature (in degrees).