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Peyronie’s disease is a fibroproliferative disorder of the tunica albuginea of the penis, leading to fibrous plaque formation, progressive penile curvature, pain, and sometimes erectile dysfunction. It is a localized connective tissue disorder, most common in middle-aged to older men.
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| Feature | Description |
|---|---|
| Affected structure | Tunica albuginea (fibrous sheath surrounding corpora cavernosa) |
| Mechanism | Repetitive microtrauma during intercourse → abnormal wound healing → fibrosis and calcification |
| Disease course | Initial active/inflammatory phase → chronic fibrotic/stable phase |
| Feature | Description |
|---|---|
| Prevalence | ~3–9% of adult men |
| Age | Peak incidence: 50–60 years |
| Risk factors | Diabetes, Dupuytren’s contracture, trauma, connective tissue disorders, penile fracture history |
| Phase | Symptoms |
|---|---|
| Acute/inflammatory | Penile pain (especially during erection), palpable plaque, mild curvature |
| Chronic/fibrotic | Stable penile deformity, curvature (>30°), penile shortening, erectile dysfunction |
| Palpable lesion | Firm, non-tender plaque along dorsal or dorsolateral shaft |
| Sexual dysfunction | Due to curvature, deformity, pain, or associated vascular disease |
| Modality | Imaging features |
|---|---|
| US | US is best for real-time, high-resolution detection of superficial plaques, especially in the dorsal shaft. |
| • Hyperechoic, calcified plaques in tunica albuginea, usually dorsal | |
| • Non-calcified plaques: hypoechoic or heterogeneous | |
| • Doppler: Assess penile vascularity and arterial inflow; may show decreased flow if vascular compromise | |
| • Elastography: May quantify stiffness of fibrotic plaques (optional in chronic phase) | |
| MR | Indications: Atypical cases, deep plaques, surgical planning, or suspected intracavernosal involvement |
| • T1: Plaques appear as low-to-intermediate signal | |
| • T2: Low signal intensity (fibrosis/calcification) in tunica albuginea | |
| • Post-contrast: May show enhancement in early/inflammatory stage | |
| XR | Dystrophic calcifications along dorsal shaft |
Peyronie disease. A 50-year-old male presented at the urology department because of bending of the penis to the right since an episode of a crackling sound during sexual activity half a year ago, along with feeling penile pain during erection. a, b Axial and sagittal T2-weighted images show low signal intensity in the right lateral tunica albuginea to corpus cavernosum, indicating the presence of plaques (arrows). The diagnosis of Peyronie disease was made based on the typical clinical course and the findings of MRI
Kimura, K., Yamamoto, T., Tsuchiya, J. et al. A diagnostic approach of various urethral diseases using multimodal imaging findings: comprehensive overview. Abdom Radiol 49, 4416–4436 (2024). https://doi.org/10.1007/s00261-024-04435-0
| Condition | Distinguishing Features |
|---|---|
| Penile fracture | History of trauma, tunica disruption, hematoma |
| Calcified corpus cavernosa | Deep, not limited to tunica; diffuse cavernosal involvement |
| Penile cancer | Irregular mass, T2 hyperintensity, heterogeneous enhancement |
| Vascular erectile dysfunction | No palpable plaque; abnormal cavernosal artery Doppler parameters |
| Phase | Treatment Options |
|---|---|
| Acute (active) | NSAIDs, pentoxifylline, oral vitamin E, collagenase Clostridium histolyticum (CCH) injections |
| Chronic (stable) | Surgery for severe deformity or functional disability: |
| • Plaque excision + grafting | |
| • Plication procedures | |
| • Penile prosthesis (if erectile dysfunction present) | |
| • Traction therapy: Penile extenders to reduce curvature and shortening |