Editing Peyronie's Disease (section)

=== History and Physical exam ===

==== History ====
* '''Signs and Symptoms'''
**'''Onset''', duration, acquired vs. lifelong (to differentiate PD vs. congenial penile curvature), changes over time (deformity and erectile function)
** '''Penile characteristics:''' extent of penile '''deformity''', direction of '''curvature''', palpable plaque(s), presence of hourglass deformity, shortening, and presence of hinging, penile '''pain''' with and without erection. Penile sensation, ejaculatory function, and length/girth concerns should be documented. 
*** '''<span style="color:#ff0000">Pain, when present in the acute phase, can occur in the flaccid penis with palpation of the plaque, with erection, or during intercourse</span>'''
*** '''<span style="color:#ff0000">Once the disease process is stable, most pain will resolve</span>, but in some men the pain persists with a pulling sensation on the plaque when a strong erection occurs (torque pain)'''
* '''<span style="color:#ff0000">Risk factors</span>'''
**History of traumatic event
**Medical history inclusive of family presence of Peyronie disease, Dupuytren’s contracture, and other related conditions that may impact erectile and sexual function.
*'''<span style="color:#ff0000">Sexual function</span>''': erectile '''rigidity,''' '''interference with intercourse,''' ability to penetrate, ability to complete intercourse, and partner complaints and support should be documented. The use of the International Index of Erectile Function-5 (IIEF-5) or the Disease Questionnaire Peyronie’s (PDQ), which is a newer, 15-item, validated instrument specific to Peyronie disease may be of use.
* '''Psychologic impact: Many men with PD experience emotional distress, depressive symptoms, and relationship difficulties.''' PD can have a profound negative impact on men’s QoL.
** Based on bother/psychologic impact, consideration may be made for referral to a mental health professional with expertise in sexuality.
* Prior Peyronie disease and ED treatments should be documented.
*'''AUA Guidelines: “The recent onset of penile curvature and varying degrees of penile pain, without a palpable penile abnormality, in the non-erect state, may be considered diagnostic”'''
* '''<span style="color:#ff0000">A diagnosis of ED or failed first- and second-line ED treatments warrants ruling out Peyronie disease</span>'''

==== Physical exam ====
[[File:Peyronie's disease.jpg|alt=Patient with ventral penile curvature.|thumb|Patient with ventral penile curvature. Source: [[commons:File:Peyronie's_disease.jpg#/media/File:Peyronie's_disease.jpg|Wikipedia]]]]
* '''<span style="color:#ff0000">Penis</span>''' 
**'''<span style="color:#ff0000">Should be examined on stretch</span>'''
**'''Assess for palpable abnormalities'''
***'''<span style="color:#ff0000">Plaque(s) can be palpated or documented on ultrasound.</span>'''
*** '''Identify the location, size, number and tenderness of the plaque'''
**** '''<span style="color:#ff0000">Most common location of plaque is on the dorsal mid-shaft</span>'''
**** Measurement of size of the plaque with any modality, including imaging, has been found to be inaccurate
** '''<span style="color:#ff0000">Prior to any intervention, measurement of stretched penile length,</span> from the penopubic skin junction to the coronal sulcus or the tip is recommended to establish baseline penile length''' as penile length loss is a primary concern and contributor to distress for Peyronie disease patients
**Digital home photographic documentation may aid in objectively determining treatment effects, especially when non-surgical options are used