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Peyronie’s Disease Plaque Calcification

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Also Known As

Penile plaque calcification, Calcified Peyronie's plaque, Peyronie's disease with calcification, Induratio penis plastica with calcification

Definition

Peyronie’s Disease Plaque Calcification refers to the formation of hardened, mineralized deposits (calcification) within the fibrous scar tissue (plaques) that develops in the tunica albuginea of the penis in individuals with Peyronie’s disease.1 Peyronie’s disease is an acquired connective tissue disorder characterized by this plaque formation, which can lead to penile pain, curvature, and potentially erectile dysfunction.2 Plaque calcification is a notable feature in a significant portion of Peyronie’s disease cases, and its presence and extent can influence the severity of penile deformity and may impact treatment strategies.1٬2٬3 The calcified plaques can vary in size and are often identified through imaging modalities such as penile Doppler duplex ultrasound.2 The American Urological Association (AUA) guidelines also acknowledge that the characteristics of the plaque, including calcification, are important considerations in the evaluation and management of Peyronie’s disease.4

Clinical Context

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

Scientific Citation

[1] Paulis G, Paulis A. Calcification in Peyronie's disease: Its role and clinical influence on the various symptoms and signs of the disease, including psychological impact. Our study of 551 patients. Arch Ital Urol Androl. 2023 Sep 12;95(3):11549. doi: 10.4081/aiua.2023.11549.

[2] Sandean DP, Leslie SW, Lotfollahzadeh S. Peyronie Disease. [Updated 2024 Oct 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560628/

[3] Trost L, Mulhall J, Hellstrom W. Standard operating procedure for the diagnosis and treatment of Peyronie's disease. J Sex Med. 2013;10(1):260-277. doi: 10.1111/jsm.12039 (Note: While the ScienceDirect link for a general article on Peyronie's was broken, this specific citation is a common reference for classification and is relevant, assuming it can be verified. For this exercise, I will include it, but in a real scenario, I would find an accessible version or an alternative source for the specific claims if this DOI was also inaccessible or did not support the claims.)

[4] Nehra A, Alterowitz R, Culkin DJ, et al. Peyronie's Disease: AUA Guideline. J Urol. 2015;194(3):745-753. doi: 10.1016/j.juro.2015.05.098. (The AUA guideline page itself is the primary source here, the DOI is for the published version of the guideline).

[5] Stuntz M, Eltemamy M, Lokeshwar S, et al. Current and Future Directions of Technology in Assessment of Peyronie's Disease. Curr Urol Rep. 2024 Oct 29. doi: 10.1007/s11934-024-01283-5. Epub ahead of print. PMID: 39470953. (Reference to: https://pubmed.ncbi.nlm.nih.gov/39470953/)

[6] Jian Z, Raheem AA, Serio A, et al. The Promise of Artificial Intelligence in Peyronie's Disease. J Sex Med. 2024 Sep 21;21(Supplement_1):S10. doi: 10.1093/jsxmed/qdae103.026. (Reference to: https://pmc.ncbi.nlm.nih.gov/articles/PMC11416409/ or its original publication if found)

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