Editing CUA: Peyronie's Disease (2018) (section)

===== '''Diagnosis and Evaluation''' =====

* '''Mandatory (1): history and physical exam'''
** '''History''': Onset, duration, history of traumatic event if applicable, deformity and erectile changes over time, acquired vs. lifelong (to differentiate Peyronie disease vs. congenial penile curvature), and medical history inclusive of family presence of Peyronie disease, Dupuytren’s contracture, and other related conditions that may impact erectile and sexual function. Prior Peyronie disease and ED treatments should be documented.
** '''Penile characteristics''': Determine the extent of penile deformity, direction of curvature, presence of hourglass deformity, palpable plaque(s), interference with intercourse, penile pain with and without erection, shortening, quality of penile rigidity, and presence of hinging. Penile sensation, ejaculatory function, and length/girth concerns should be documented. Digital home photographic documentation may aid in objectively determining treatment effects, especially when non-surgical options are used.
** '''Sexual function''': Erectile rigidity, 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. Based on bother/psychologic impact, consideration may be made for referral to a mental health professional with expertise in sexuality.
*** '''A diagnosis of ED or failed first- and second-line ED treatments warrants ruling out Peyronie disease'''
** '''Physical exam:'''
*** '''The penis should be examined on the stretch.''' Palpation should be performed to identify the location, size, number and tenderness of the plaque. '''Stretched penile length can be determined''', as penile length loss is a primary concern and contributor to distress for Peyronie disease patients; this is measured from the penopubic skin junction to the coronal sulcus or the tip of the penis.
*** '''Prior to non-invasive or invasive treatments (intralesional injection therapy or surgery) and to monitor treatment effect, it is recommended to examine the erection to determine erect penile length, degree of curvature, hourglass deformities, and rigidity of erection. This can be done with digital photographs or examination after penile injection of vasoactive agents (AUA prefers this);''' '''penile injection remains the gold standard, especially in patients reporting complex deformity (hourglass or bidirectional curvature) or ED'''
*** An accurate appraisal of the deformity includes identifying the type(s), magnitude or severity, and evaluating penile stability/buckling'''. The most reliable means of assessing deformity is the use of intracavernosal injections, with or without colour duplex ultrasonography.'''
* '''Optional/not recommended:'''
** '''Imaging:'''
*** '''Colour duplex ultrasonography may be offered, but may not be readily available'''; combination of ultrasound with intracavernosal injection may also identify arterial insufficiency or veno-occlusive dysfunction, influencing choice of Peyronie disease management
*** '''MRI is an excellent imaging modality for penile pathology,''' including Peyronie disease, '''but its routine use in clinical practice is not supported'''
*** CT and plain radiography do not have a role
** '''Laboratory:'''
*** '''Routine laboratory testing is not recommended'''; however, targeted bloodwork may be obtained in response to specific findings on history or physical examination (for example, signs/symptoms of hypogonadism)