NC.com

History

• Symptoms: pain, deformity, palpable plaque, and erectile dysfunction
• ED vs PD: ask, "if your penis was straight with the same quality of rigidity you have now, do you think it would be adequate for penetrative sexual activity?", ED treatments unlikely to cause Peyronie, but more likely to expose patients who would otherwise not notice
• Assess ED risk factors: DM, HTN, HLD, smoking
• Resolution:50% see worsening curvature 12-18 months after presentation, 13% or less see some improvement
• Risk factors: prior trauma, sexual microtrauma, DM, low T, smoking, alcohol, ED, associated with depression, anxiety, and other psychosocial issues, some association with Dupuytren disease (hand/foot contractures)
• Questionnaire: assess severity with the PDQ (PDF here)

Exam and adjuncts

• Ask to bring picture from home of erection from above and from the side
• Exam: examine penis on stretch and palpate for plaques, can use goniometer to accurately measure curvature severity
• Stretched penile length: pubis to corona dorsally
• Further testing: no benefit to US or lab evaluation
• Intracavernosal injection: recommended to perform in-office prior to any invasive therapies
• congenital penile curvature (CPC): important to differentiate, shows smooth curvature on exam without plaques