—Dr. Trost Commentary and Key Take-home Points—
The best method for objectively evaluating penile curvature and deformity is an office-based assessment following injection of a medication to result in an erection. Other methods of assessment, including patient self assessment, home photography, CT imaging, 3d photography, and app-based assessments all fail to achieve as consistent results or provide additional benefits over the more traditional office-based assessment. However, office-based assessments are not perfect and are limited by the strength of erection achieved and the experience of the practitioner assessing.
Introduction
There are various methods used to evaluate penile deformities and surgical planning in men presenting with Peyronie’s Disease (PD). In a pilot study by Dr. Kadioglu et al, the authors sought to determine the effectiveness between 3 methods of evaluation: auto-photography, combined intracavernous injection stimulation test (CIS) and 3-dimensional computed tomography (3D CT).
Methods
The following 3 methods were used to detect deformities and determine the necessity of surgical intervention for men with PD. The aim of each method is to discover direction and severity of penile deformity, degree of curvature, circumference and distance from notched deformities, and deformity location.
- Auto-photography: patients are asked to photograph their own penis during maximal erection from 3 angles while at home. This gives a 2-dimensional image for the doctors to use.
- CIS (combined injection and stimulation): performed in the office with artificial erection while the doctor examines and measures the penis and it’s deformities. Both visual and manual examination is applied.
- 3D-CT (non-contrast): reconstructed 3D images are combined to determine the type and angle of deformity, length and circumference, exact location and degree of curvature.
Results
Degrees of penile curvature for each method was 24 degrees for auto-photography, 40 degrees for CIS and 34 degrees for CT. A moderate correlation was found between auto-photography and CIS, while a strong correlation was found between CIS and CT, though that correlation was stronger for ventral and right-sided curvature than for ventral and left-sided or ventral and dorsal curvatures. CIS was able to detect 100% of notching deformities in patients with complex deformities, while 83% were found with CT and 67% with auto-photography.
Discussion
Auto-photography presents a limitation in lack of control over quality of photography and quality of erection obtained, which sometimes results in over or under-estimation of curvature. This makes it insufficient to determine which treatment option is best or which surgical operation may be needed. CIS is seen as the gold standard method in this study because of accuracy, cost effectiveness and least risk; however, CT has a strong correlation with CIS and is also reliable as a tool for surgical planning.
Conclusion
The study concluded that CIS is the most cost-effective method for evaluating PD deformity as it was as accurate, or more so, than auto-photography and CT scans and didn’t require radiation. Still, 3D-CT images have a strong correlation with CIS and can be a useful aid in planning for surgical treatment options.
Reference for Article
Özmez A1, Ortac M1, Cevik G2, Akdere H2, Bakır B3, Kadıoğlu A4. Sex Med. 2019 Jul 16. pii: S2050-1161(19)30070-4. doi: 10.1016/j.esxm.2019.06.009. [Epub ahead of print]