Combining ultrasound and elastography for the detection of a non-palpable, non-sonographically visualized Peyronie's plaques. Our experience

Submitted: May 26, 2024
Accepted: June 13, 2024
Published: October 2, 2024
Abstract Views: 107
PDF: 48
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Background: B-mode ultrasound (US) medical imaging is very effective in localizing and describing Peyronie's disease (PD). Moreover, elastography is a new technique used to evaluate tissue elasticity to detect penile Peyronie's plaques that are not visible using standard B-mode US.
Objective: The main objective of this study was to evaluate the diagnostic efficacy of real-time elastography (RTE) in PD patients and to determine whether its combined use with standard US improved diagnostic accuracy. RTE is also known as strain elastography (SE). Additionally, this study aimed to assess whether RTE was useful for monitoring PD patients undergoing conservative treatment.
Methods: A group of 37 PD patients in the active phase was selected based on US examination showing isoechoic or hypo-isoechoic plaques, with or without associated hyperechoic or calcified plaque areas. All patients underwent traditional US combined with RTE before starting conservative treatment with antioxidants, during treatment and after treatment. After each examination with RTE, a specific “Strain Ratio”(SR) was used to identify the specific elasticity of the tissue.
Results: Using B-mode US with RTE, we detected all 13 non-palpable penile plaques present in the 37 PD patients (100% of cases). Using only B-mode US, we detected only 8 of the 13 non-palpable plaques (61.5% of cases). The DI of the plaque decreased during and after treatment in all cases, indicating that RTE is effective for monitoring conservative PD treatment. A statistically significant correlation was found between the DI and plaque volume in all patients (p=0.002).
Conclusion: Our study has shown that the combination of US and RTE methods allowed for a more accurate diagnosis in PD patients.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Herati AS, Pastuszak AW. The genetic basis of Peyronie disease: a review. Sex Med Rev. 2016;4:85-94.
Bias WB, Nyberg LM Jr, Hochberg MC, Walsh PC. Peyronie's disease: a newly recognized autosomal-dominant trait. Am J Med Genet. 1982;12:227-35.
Hellstrom WJ, Bivalacqua TJ. Peyronie’s disease: Etiology, medical, and surgical therapy. J Androl. 2000;21:347-54.
Rhoden EL, Teloken C, Ting HY, et al. Prevalence of Peyronie's disease in men over 50-y-old from Southern Brazil. Int J Impot Res. 2001;13:29193.
La Pera G, Pescatori ES, Calabrese M, et al. Peyronie's disease: prevalence and association with cigarette smoking. A multicenter population-based study in men aged 50-69 years. Eur Urol. 2001;40:525-30.
Schwarzer U, Sommer F, Klotz T, et al. The prevalence of Peyronie's disease: results of a large survey. BJU Int. 2001;88:727-30.
Johnson HM, Weerakoon P, Stricker PD. The incidence, aetiology, and presentation of Peyronie’s disease in Sydney, Australia. J Sex Disabil. 2002;20:109-16.
DiBenedetti DB, Nguyen D, Zografos L, et al. A population-based study of Peyronie’s disease: prevalence and treatment patterns in the United States. Adv Urol. 2011;2011:282503.
Shiraishi K, Shimabukuro T, Matsuyama H. The prevalence of Peyronie’s disease in Japan: A study in men undergoing maintenance hemodialysis and routine health checks. J Sex Med. 2012;9:2716-23.
Stuntz M, Perlaky A, des Vignes F, et al. The prevalence of Peyronie’s Disease in the United States: A population-based study. PLoS One. 2016;11:e0150157.
Kyei MY, Mensah JE, Asante E, et al. Peyronie’s Disease in People of African Origin: A Mini Review. J Gerontol Aging Res 2017;1:104.
Bella AJ, Lee JC, Grober ED, et al. 2018 Canadian Urological Association guideline for Peyronie’s disease and congenital penile curvature. Can Urol Assoc J. 2018;12:E197-E209.
Weidner W, Schroeder-Printzen I, Weiske WH, et al. Sexual dysfunction in Peyronie’s disease: An analysis of 222 patients without previous local plaque therapy. J Urol. 1997;157:325-8.
Nelson CJ, Diblasio C, Kendirci M, et al. The chronology of depression and distress in men with Peyronie’s Disease. J Sex Med. 2008;5:1985-90.
Paulis G, Romano G, Paulis A. Prevalence, psychological impact, and risk factors of erectile dysfunction in patients with Peyronie’s disease: A retrospective analysis of 309 cases. Res Rep Urol. 2016;8:95-103.
Wong A, Tsang SS, O RY, et al. Mp33-12 Prevalence of Peyronie’s disease and its psychosexual impact in the chinese population: A large cohort population-based cross-sectional study. J Urol. 2020;203:e499.
Kuja-Halkola R, Henningsohn L, D’Onofrio BM, et al. Mental Disorders in Peyronie’s Disease: A Swedish Cohort Study of 3.5 Million Men. J Urol. 2021;205:864-70.
Devine CJ Jr, Somers KD, Ladaga LE. Peyronie’s disease: Pathophysiology. Prog Clin Biol Res. 1991;370:355-8.
Devine CJJ, Somers KD, Jordan GH, et al. Proposal: Trauma as a cause of Peyronie’s lesion. J Urol. 1997:157:285-90.
Jarow JP, Lowe FC. Penile trauma: An etiologic factor in Peyronie’s disease and erectile dysfunction. J Urol. 1997;158:1388-90.
Segal RL, Burnett AL. Surgical Management for Peyronie's Disease. World J Mens Health. 2013;31:1–11.
El-Sakka AI, Salabas E, Dinçer M, et al. The pathophysiology of Peyronie’s disease. Arab J Urol. 2013;11:272–7.
Paulis G, Romano G, Paulis L, et al. Recent pathophysiological aspects of Peyronie’s disease: role of free radicals, rationale, and therapeutic implications for antioxidant treatment-literature review. Adv Urol. 2017;2017:4653512.
Paulis G, De Giorgio G, Paulis L. Role of Oxidative Stress in Peyronie’s Disease: Biochemical Evidence and Experiences of Treatment with Antioxidants. Int J Mol Sci. 2022;23:15969.
Sikka SC, Hellstrom WJ. Role of oxidative stress and antioxidants in Peyronie’s disease. Int J Impot Res. 2002;14:353-60.
Paulis G, Brancato T. Inflammatory mechanisms and oxidative stress in Peyronie’s disease: Therapeutic “rationale” and related emerging treatment strategies. Inflamm Allergy Drug Targets 2012;11:48–57.
Davila HH, Magee TR, Vernet D, et al. Gene transfer of inducible nitric oxide synthase complementary DNA regresses the fibrotic plaque in an animal model of Peyronie’s disease. Biol Reprod. 2004;71:1568-77.
Bivalacqua TJ, Champion HC, Hellstrom WJ. Implications of nitric oxide synthase isoforms in the pathophysiology of Peyronie’s disease. Int J Impot Res. 2002;14:345-52.
Gonzalez-Cadavid NF, Magee TR, et al. Gene expression in Peyronie’s disease. Int J Impot Res. 2002;14:361-74.
McCauley JF, Dean RC. Diagnostic utility of penile ultrasound in Peyronie's disease. World J Urol. 2020;38:263–8.
Kelâmi A. Autophotography in evaluation of functional penile disorders. Urology 1983;21:628–9.
Parmar M, Masterson JM, Masterson TA, 3rd. The role of imaging in the diagnosis and management of Peyronie's disease. Curr Opin Urol. 2020;30:283–9.
Lahme S, Zimmermanns V, Liske P, et al. Real-Time Elastography (RTE) in patients with Peyronie’s disease: first results of a new imaging technique for the detection and mesurement of plaques. J Urol. 2009;181:280.
Morana C, Loiero G, Sangiorgio A, et al. Elastosonography in the Peyronie's disease: our preliminary experience. Arch Ital Urol Androl. 2010;82:269–70.
Riversi V, Tallis V, Trovatelli S, et al. Realtime-elastosonography of the penis in patients with Peyronie's disease. Arch Ital Urol Androl. 2012;84:174–7.
Zhao S, Wu X, Zhang Y, et al. Role of shear wave elastography in the diagnosis of Peyronie disease. J Ultrason Med. 2024;43:397-403.
Ophir J, Céspedes I, Ponnekanti H, et al. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging 1991;13:111–34.
Zhang X, Zhou B, Miranda AF, et al. A novel noninvasive ultrasound vibro-elastography technique for assessing patients with erectile dysfunction and Peyronie disease. Urology 2018;116:99–105.
Trama F, Riccardo F, Ruffo A, et al. Elastosonographic changes in patients with Peyronie's disease, before and after treatment with a compound based on Ecklonia bicyclis, Tribulus terrestris, and water-soluble chitosan. Open J Urol. 2018;8:77-87.
Tyloch JF, Tyloch DJ, Adamowicz J, et al. Application of three-dimensional ultrasonography (3D ultrasound) to pretreatment evaluation of plastic induration of the penis (Peyronie's disease). Med Ultrason. 2020;22:159-63.
Trama F, Illiano E, Iacono F, et al. Use of penile shear wave elastosonography for the diagnosis of Peyronie's Disease: a prospective case-control study. Basic Clin Androl. 2022;32:15.
Richards G, Goldenberg E, Pek H, et al. Penile sonoelastography for the localization of a non-palpable, non-sonographically visualized lesion in a patient with penile curvature from Peyronie's disease. J Sex Med. 2014;11:516–20.
Dhawan S, Dhok A, Phatak S, et al. Peyronie's Disease presenting as curvature of the penis: a case report. Cureus 2022;14:e32055.
Simon V, Dudea SM, Crisan N, et al. Elastography in the urological practice: urinary and male genital tract, prostate excluded-Review. Diagnostics (Basel) 2022;12:1727.
Shiina T, Nightingale KR, Palmeri ML, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology. Ultrasound Med Biol. 2015;41:1126–47.
Kelâmi A. Autophotography in evaluation of functional penile disorders. Urology. 1983;21:628–9.
Eri LM, Thomassen H, Brennhovd B, et al. Accuracy and repeatability of prostate volume measurements by transrectal ultrasound. Prostate Cancer Prostatic Dis. 2002;5:273–8.
Lee JS, Chung BH. Transrectal ultrasound versus magnetic resonance imaging in the estimation of prostate volume as compared with radical prostatectomy specimens. Urol Int. 2007;78:323-7.
Rosen RC, Riley A, Wagner G, et al. The international index of erectile function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology 1997;49:822–30.
Kahl C, Cleland JA. Visual analogue scale, numeric pain rating scale and the McGill pain Questionnaire: An overview of psychometric properties. Phys Ther Rev. 2005;10:123–8.
Spitzer RL, Kroenke, K, Williams, JB, et al. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch. Intern. Med. 2006;166:1092–7.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.
Dell'Atti L, Galosi AB. Sonographic patterns of Peyronie's disease in patients with absence of palpable plaques. Int Braz J Urol 2018;44:362–9.
Lopez JA, Jarow JP. Duplex ultrasound findings in men with Peyronie's disease. Urol Radiol. 1991;12:199–202.
Odiase VO, Whitaker RH. Peyronie's disease in a district general hospital. Postgrad Med J. 1980;56:773-6.
Prando D. New sonographic aspects of peyronie disease. J Ultrasound Med. 2009;28:217-32.
Kalokairinou K, Konstantinidis C, Domazou M, et al. US Imaging in Peyronie's Disease. J Clin Imaging Sci. 2012;2:63.
Liu Y, Zheng D, Liu X, et al. Ultrasound on erect penis improves plaque identification in patients with Peyronie's Disease. Front Pharmacol. 2019;10:312.
Smith JF, Walsh TJ, Conti SL, et al. Risk factors for emotional and relationship problems in Peyronie's disease. J Sex Med. 2008;5:2179-84.
Nelson CJ, Mulhall JP. Psychological impact of Peyronie's disease: a review. J Sex Med. 2013;10:653–60.
Taylor FL, Levine A. Peyronie's Disease. Urol Clin North Am. 2007;34:517-34.
Bella AJ, Perelman MA, Brant WO, et al. Peyronie's disease (CME). J Sex Med. 2007;4:1527–38.
Jordan GH, Carson CC, Lipshultz LI. Minimally invasive treatment of Peyronie's disease: evidence-based progress. BJU Int. 2014;114:16–24.
Porst H, Burri A, European Society for Sexual Medicine (ESSM) Educational Committee Current Strategies in the Management of Peyronie's Disease (PD)-Results of a Survey of 401 Sexual Medicine Experts Across Europe. J Sex Med. 2019;16:901-8.
El-Sakka AI. Medical, non-invasive, and minimally invasive treatment for Peyronie's disease: A systematic review. Andrology. 2021;9:511-28.

How to Cite

Paulis, G., De Giorgio, G., & Paulis, A. (2024). Combining ultrasound and elastography for the detection of a non-palpable, non-sonographically visualized Peyronie’s plaques. Our experience. Archivio Italiano Di Urologia E Andrologia, 96(3). https://doi.org/10.4081/aiua.2024.12690