Often these cardinal symptoms are accompanied by a constellation of other issues, including penile shortening and/or narrowing, loss of erectile rigidity throughout the penis or distal to the plaque, and decreased penile sensation. A recent report from Tom Lue's group in San Francisco describes a subset of patients with suspected PD who were found to have only a circumscribed septal lesion (CSL) on penile ultrasonography. In the review, published in the January 2007 issue of the Journal of Urology, the characteristics of this subset of patients are reviewed.

Of a series of 650 patients with Peyronie's disease, 47 patients were identified with isolated septal fibrosis on ultrasound. Patients with any additional lesions, such as peripheral plaques, were excluded from the group. Of the group of 47 patients, 33 presented with classic findings of Peyronie's disease including penile pain or curvature. Four men presented with erectile dysfunction. Seven men presented with a primary complaint of penile shortening or distal softening, of whom 3 reported a lump in the mid shaft of the penis. A total of 17 patients had a significant history of penile trauma, but not a penile fracture. The event occurred within 6 months of presentation in all men. In three men presenting soon after their traumatic injuries, a well-defined cystic area in the septal region was found on ultrasound. These areas were found to be liquefied hematomas and were aspirated under ultrasound guidance. In one case, the hematoma was adjacent to a smaller, more typical appearing CSL, and in one patient, a follow-up ultrasound demonstrated evolution to a smaller but otherwise typical CSL. All of these men, who had complained of ED after their traumatic injuries, had complete resolution of their erectile dysfunction within 4 weeks of aspiration.

The authors believe that these septal lesions may actually represent septal fractures and that early intervention with ultrasonographic aspiration may prevent formation of a typical Peyronie's plaque, albeit in the septum, and prevent the complication of fibrosis, penile curvature and other stigmata of Peyronie's disease. The authors also discuss their use of the anti-inflammatory Pentoxifyline in divided doses of 800 to 1,600 mg daily to fight the inflammatory component of Peyronie's disease.

Brant WO, Bella AJ, Garcia MM, Tantiwongse K, Dean RC, Lue TF

J Urol. 2007 Jan; 177(1): 179-183

Written by Michael J. Metro, MD, a Contributing Editor with UroToday.

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