Plaque-associated corporal veno-occlusive dysfunction in idiopathic Peyronie's disease: A pharmacocavernosometric and pharmacocavernosographic study

Summary

The hemodynamic characteristics of 92 patients with idiopathic Peyronie's disease who underwent a dynamic-infusion pharmacocavernosometry and pharmacocavernosography (DICC) examination as part of their initial evaluation were reviewed. In all, 86% of patients demonstrated cavernosometric evidence of corporal veno-occlusive dysfunction. A 71% incidence of corporal veno-occlusive dysfunction was seen by cavernosometry in patients without vascular risk factors, suggesting that Peyronie's disease may be associated with intrinsic alterations in the penile fibroelastic frame compliance. In 62% of patients with abnormal cavernosography, a unique, heretofore undescribed cavernosographic “pitchfork” pattern was observed, derived from the abrupt filling of the dorsal vein and the corpus spongiosum just proximal to the Peyronie's plaque. Delamination, subsequent inflammation, and plaque formation at the junction of the dorsal and ventral circular fibers of the tunica with the fibers of the septum may account for this unique pattern of plaque-associated venous drainage. In all, 78% of patients demonstrated abnormal cavernosal artery systolic occlusion pressures as compared with simultaneous brachial artery systolic occlusion pressures. Hemodynamic abnormalities were observed in patients having regular intercourse and in those denying changes in the quality of their penile erections. To aid in the management of the disorder, it is suggested that prior to treatment, especially reconstructive surgery, a hemodynamic assessment of the erectile mechanism by DICC be performed.