ORIGINAL RESEARCH—PEYRONIE’S DISEASE Penile Sonographic and Clinical Characteristics in Men with Peyronie’s Disease James F. Smith, MD, MS,* § William O. Brant, MD, † Vincent Fradet, MD,* Alan W. Shindel, MD,* Eric Vittinghoff, PhD, ‡ Thomas Chi, MD,* Yun-Ching Huang, MD,* Cole B. Davis, MD,* Simon Conti, BS,* and Tom F. Lue, MD* *University of California—Department of Urology, San Francisco, CA, USA; † University of Utah—Division of Urology, Salt Lake City, UT, USA; ‡ University of California—Department of Epidemiology and Biostatistics, San Francisco, CA, USA; § Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco DOI: 10.1111/j.1743-6109.2009.01438.x ABSTRACT Introduction. Ultrasonography of the penis is readily available to the urologist and gives good anatomic detail of soft tissue structures. It has not been widely utilized in the assessment of Peyronie’s disease (PD). Aims. To describe the sonographic characteristics of the penis in PD and the relationship between clinical and sonographic features. Methods. This cross-sectional study enrolled patients from a single clinical practice. A PD-specific questionnaire was administered and sonographic evaluations were performed. Main Outcome Measures. Sonographic characteristics of men with PD. Results. Tunical thickening, calcifications, septal fibrosis, and intracavernosal fibrosis, were observed at initial clinical evaluation in 50%, 31%, 20%, and 15% of men, respectively. Men aged 40–49 (OR 2.4, P = 0.02) and men aged 50–59 (OR 2.4, P = 0.004) were more likely to have sub-tunical calcifications relative to men under age 40. Men with septal fibrosis had fewer chronic medical conditions such as diabetes (OR 0.3, P = 0.04), hypertension (OR 0.5, P = 0.03), and coronary artery disease (OR 0.2, P = 0.05), and presented within 1 year of disease onset (OR 2.1, P = 0.001). Men with septal fibrosis were less likely to have lost penile length (OR 0.5, P = 0.04) and more likely to be able to have intercourse (OR 1.9, P = 0.05). Men with intracavernosal fibrosis were less likely to have penile pain (OR 0.5, P = 0.05), but more likely to have penetration difficulty during intercourse (OR 1.9, P = 0.008), an additional penile deformity (OR 1.8, P = 0.02), or rapid onset of disease (OR 1.7, P = 0.04). Tunical thickening was associated with a decreased ability to have intercourse (OR 2.3, P < 0.001). Conclusion. PD is a clinically and sonographically heterogeneous condition. Sonography is a safe, low-cost, and rapid means of objectively characterizing lesions in this condition. This may help track the evolution of the condition in individual patients and in the future may be useful for tailoring treatment strategies. Smith JF, Brant WO, Fradet V, Shindel AW, Vittinghoff E, Chi T, Huang YC, Davis CB, Conti S, and Lue TF. Penile sonographic and clinical characteristics in men with Peyronie’s disease. J Sex Med 2009;6:2858–2867. Key Words. Calcification; Septal Fibrosis; Intracavernosal Fibrosis; Tunical Thickening; Peyronie’s Disease; Ultrasound Introduction P eyronie’s disease (PD) is a relatively common disorder in men (3–9%) that is typically asso- ciated with penile deformity, pain, and fibrotic and/or calcific transformation of tunical tissues [1–3]. The mechanisms of Peyronie’s plaque for- mation are not fully understood, although it is theorized that inflammation of the tunica albug- inea [4] secondary to trauma may lead to fibrosis with decreased elasticity, less effective wound healing, and excess collagen deposition [5]. While 2858 J Sex Med 2009;6:2858–2867 © 2009 International Society for Sexual Medicine