Color Doppler ultrasound assessment of penile vascular system in men with Peyronie's disease A Kadi : og Ælu 1 *, A Tefekli 1 , H Erol 1 , S Cayan 1 and E Kandi : rali : 1 1 Department of Urology, Medical Faculty of Istanbul, University of Istanbul, Turkey The purpose of this study was to evaluate the penile vascular function by color Doppler ultrasonography (CDU) in patients with Peyronie's disease. A total of 136 men with Peyronie's disease were strati®ed according to their potency by history as Group I consisting of potent patients and Group II consisting of patients with erectile dysfunction. They were all evaluated by penile CDU. Overall, 70.6% had erectile dysfunction by history. CDU revealed penile vascular abnormalities in 76.5%. In Group I, veno-occlusive dysfunction (VOD) was observed in 40% while mixed (arterial  venous) vascular disease was diagnosed in 10%. Penile vascular disease was detected in 87.5% patients in Group II (ie VOD in 28%, arterial disease in 9.3% and mixed vascular disease in 50%). The prevalence of arterial disease on CDU among Peyronie' patients with erectile dysfunction (59.3%) was signi®cantly (P < 0.05) higher then it was among potent patients (10%). The prevalence of pure VOD was almost similar for patients with or without erectile dysfunction (P < 0.05). We conclude that penile vascular abnormalities can be observed in 76.5% on cases with Peyronie's disease by CDU and this ratio signi®cantly increases to 87.5% among cases with erectile dysfunction by history. Our data also indicate that arterial disease, accounts for much of the diminished rigidity in men with Peyronie's disease. International Journal of Impotence Research (2000) 12, 263±267. Keywords: Peyronie's disease; erectile dysfunction; color Doppler ultrasonography Introduction Peyronie's disease is characterized by ®brosis throughout the entire thickness of the tunica albuginea of the corpora cavernosa. Pain on erec- tion, curvature and palpable plaque on the shaft of penis are the most common presenting symptoms. 1,2 Although it was once considered a rare condition, 1 ± 2% incidence of symptomatic Peyronie's disease has been found in different populations of male physicians. 1,3 ± 5 The disease is most commonly seen in the men in their ®fties and affects approximately 10% of men with erectile dysfunction. 5,6 Patients with Peyronie's disease do not have a common starting point but two discernable phases are usually noted during the progression of the disease. 1 The acute in¯ammatory phase usually lasts about 12 ± 18 months. Pain on erection and unstable deformity are the most common presenting symptoms during this phase. It is followed by the chronic or stable phase characterized by minimal pain, stable deformity and stable plaque size. Sexual dysfunction, being a part of presenting symptoms, is reported to be 4 ± 80% among different series. 6±8 Although the excessive angulation due to the curvature, painful erection, tenderness on the plaque and performance anxiety may all contribute to erectile dysfunction (ED), it has been shown that penile vascular abnormalities are responsible for ED in 61 ± 70% Peyronie's patients. 1,7 ± 12 Veno-occlu- sive dysfunction (VOD) is reported to be present in 30 ± 86% and the role of arterial disease has also been shown in 44 ± 52% Peyronie's patients with ED although it is not easy to determine the exact etiologic factor in every case. 7 ± 12 Furthermore patients with Peyronie's disease, presenting most commonly during the ®fth decade, may only re¯ect the conditions of potency of age matched patients without Peyronie's disease. 8 Erectile function and penile vascular status are key factors in deciding the treatment modality, since patients with preserved erectile function and adequate penile vascular system are considered candidates for reconstructive surgery; while those *Correspondence: A Kadi : og Ælu, Associate Professor of Urology, Department of Urology, Medical Faculty of Istanbul, University of Istanbul, Capa 34390-Istanbul, Turkey. E-mail: atefekli@anet.net.tr Received 8 February 1999; revised 28 March 2000; accepted 4 June 2000 International Journal of Impotence Research (2000) 12, 263±267 ß 2000 Macmillan Publishers Ltd All rights reserved 0955-9930/00 $15.00 www.nature.com/ijir