Rigi10™ Malleable Penile Prosthesis
Also Known As
Penile deviation, Peyronie's disease assessment, Penile angulation measurement, Penile deformity evaluation, Penile curvature quantification, Penile bend assessment, Erectile curvature measurement, Penile plaque assessment, Penile deformity quantification,
Definition
Penile curvature assessment is a comprehensive diagnostic procedure used to evaluate and measure the degree and direction of abnormal penile angulation that occurs during erection. This condition, most commonly associated with Peyronie’s disease, involves the formation of fibrous scar tissue (plaque) within the tunica albuginea, the thick elastic membrane that surrounds the erectile tissue of the penis.1 The assessment process is essential for determining appropriate treatment strategies, monitoring disease progression, and evaluating treatment outcomes in patients with penile curvature disorders.2
The gold standard method for penile curvature assessment involves intracavernosal injection (ICI) of vasoactive substances to induce an artificial erection, followed by goniometric measurement of the angle of deviation.3 This approach provides the most accurate representation of the deformity as it closely mimics natural erectile conditions. Alternative assessment methods include at-home photography during natural erection and vacuum erection device (VED) assisted evaluation, though these methods have been shown to underestimate curvature compared to ICI-based assessment.4
Comprehensive penile curvature assessment typically includes documentation of several key parameters: the degree of curvature (measured in degrees), the direction of curvature (dorsal, ventral, lateral, or complex), the presence and location of palpable plaques, associated symptoms such as pain during erection, and any concomitant erectile dysfunction.5 Advanced assessment may also incorporate penile Doppler ultrasound to evaluate vascular flow and identify calcifications within plaques, which can influence treatment decisions.6
Proper assessment is crucial for clinical decision-making, as the magnitude and characteristics of penile curvature directly impact treatment selection between non-surgical approaches (such as oral medications, intralesional injections, or traction therapy) and surgical interventions (including plication techniques, plaque incision with grafting, or penile prosthesis implantation).7
Clinical Context
Penile curvature assessment plays a critical role in the clinical management of patients with penile deformities, particularly those with Peyronie’s disease. This comprehensive evaluation process is essential for several key aspects of patient care, including initial diagnosis, treatment planning, monitoring disease progression, and evaluating treatment outcomes.1
In the diagnostic phase, penile curvature assessment is performed when patients present with symptoms such as penile pain during erection, palpable nodules or plaques on the penis, noticeable curvature or deformity during erection, difficulty with sexual intercourse, or erectile dysfunction.2 The assessment helps differentiate Peyronie’s disease from other conditions such as congenital penile curvature, which typically presents with lateral curvature of less than 20 degrees and no palpable plaques.3
Patient selection for various treatment modalities is heavily influenced by the findings from penile curvature assessment. For patients in the acute phase of Peyronie’s disease (typically the first 12-18 months), characterized by active inflammation, progressive deformity, and penile pain, non-surgical approaches are generally recommended.4 These may include oral medications, intralesional injections, or external traction therapy. The assessment provides baseline measurements against which treatment efficacy can be evaluated.
For patients with stable disease (no pain and stable curvature for at least 3-6 months), surgical intervention may be considered based on the severity of curvature and impact on sexual function.5 Surgical options include plication techniques for curvatures less than 60 degrees without significant shortening, plaque incision with grafting for more severe curvatures or hourglass deformities, and penile prosthesis implantation for patients with concurrent erectile dysfunction.6
The gold standard assessment method using intracavernosal injection (ICI) of vasoactive substances is particularly important before any surgical intervention, as it provides the most accurate representation of the deformity.7 This approach may be supplemented with penile Doppler ultrasound to evaluate vascular flow and identify calcifications within plaques, which can influence surgical decision-making.8
Expected outcomes following treatment vary based on the intervention selected, but the primary goals typically include reduction in penile curvature to allow for satisfactory sexual intercourse, alleviation of pain, and improvement in quality of life. Regular reassessment of penile curvature using consistent methodology is crucial for objectively evaluating treatment success and guiding further management decisions.9