Peyronie’s Disease Plaque Calcification

Peyronie’s Disease Plaque Calcification is clinically relevant in the diagnosis, staging, and management of Peyronie’s disease (PD).¹٬²٬⁴ It is often identified during the physical examination or more definitively through imaging studies such as penile Doppler duplex ultrasound, which is recommended by the American Urological Association (AUA) prior to invasive interventions.²٬⁴ The presence and extent of calcification can influence the clinical course and patient symptoms. For instance, studies suggest that more extensive calcifications (e.g., >1.5 cm or multiple plaques >1.0 cm) may be associated with more severe penile curvature and a higher likelihood of requiring surgical intervention, even in patients with satisfactory erectile function.² Calcification is also a feature of the ‘calcifying Peyronie’s disease’ subtype in some clinical classification systems, which is characterized by moderate-to-severe plaque calcification and may be associated with disease progression and pain.²

Patient selection for various treatments may be influenced by the presence of calcification. While some conservative or minimally invasive treatments are attempted, significant calcification can make plaques less responsive to certain therapies, such as intralesional injections, or may be a relative contraindication for some procedures.⁴ Surgical intervention, including plaque incision/excision and grafting or penile prosthesis implantation, is often considered for patients with stable disease, significant deformity hindering intercourse, and in whom conservative measures have failed.⁴ The AUA guidelines provide a framework for treatment selection based on disease stability, curvature severity, and erectile function.⁴ For example, intralesional collagenase clostridium histolyticum is an option for stable PD with curvature >30° and <90° and intact erectile function.⁴ If erectile dysfunction is also present and refractory to medical therapy, penile prosthesis implantation is a common surgical approach, which can be combined with modeling or other straightening maneuvers.⁴

Expected outcomes vary depending on the treatment modality. The goal of treatment is to reduce penile pain (if present), correct penile curvature to allow for satisfactory intercourse, and preserve or restore erectile function.⁴ Success rates for surgical interventions are generally high in appropriately selected patients, but potential complications and the need for rehabilitation are important considerations.²٬⁴ The presence of extensive calcification might complicate surgical procedures and could influence the choice of surgical technique. For example, heavily calcified plaques may be more challenging to incise or excise.²