Ultrasonographic study of Peyronie's disease

Induratio penis plastica (IPP) is a degenerative disease, which consists in a thickening of the albuginea tunica of cavernous corpora, especially on the dorsal aspect. In 25% of the cases a calcified deposit is present. This disease can determine a bending of the penis, usually upward, pain during erection and impotentia coeundi. It is associated with Dupuytren's disease in 25% of the cases. IPP is of unknown etiological origin. The more reliable etiological theories are the degenerative one (micro trauma and inflammation) and the autoimmune one. The assessment of IPP is based on story, physical examination, autophotography (which are necessary) and on imaging techniques such as ultrasound, color Doppler, CT, MRI and X-ray in mammography. Color Doppler has demonstrated to be the best technique because of its cost/benefit and cost/effectiveness ratio. RMI with gadolinium can determine plaques activity but it has a lower cost/benefit ratio. Color Doppler can determine the presence of an IPP plaque and its status, which is size, location, and degree of calcification. Some authors sustain that inflammation can be suggested by the presence of micro vascularization around the plaque. US can be very useful to detect plaque in a size not easily accessible by physical examination (on the dorsal aspect of the penis) and to demonstrate plaques in different evolution moment. Ultrasonography is the better technique to show directly albuginea tunica. Authors illustrate the methodology, which use intra-cavernous injection of prostaglandin E1 (PGE1) to induce erection and its semeiotic findings.