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Penile Compartment Syndrome

A Possible Explanation for Penile Pain in Peyronie Disease Shown by Penile Sonography

Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (D.K., P.D.L.); and Department of Urology, Shaare Zedek Medical Center, Jerusalem, Israel (O.Z.S.).

Address correspondence to David Kisselgoff, MD, Department of Radiology, Hadassah-Hebrew University Medical Center, Ein Kerem, 91120 Jerusalem, Israel. E-mail: kisel3144{at}yahoo.com

Objective. Our purpose was to describe sonographic findings in patients with Peyronie disease that may explain persistent penile pain in these patients. We propose the term penile compartment syndrome for use in radiology and urology practice to describe this condition. Methods. Thirty-five consecutive patients were examined. All these patients had clinically "mature" plaques with Peyronie disease. Penile duplex sonography was performed as part of the patient evaluation before possible corrective surgery. Results. All patients had the classic sonographic finding of plaques in the tunica albuginea. Persistent venous insufficiency was noted in 3 patients (8.6%); we observed arterial insufficiency during dynamic evaluation of blood flow in 2 (5.8%); and in 2 cases, a low peak systolic velocity was accompanied by an abnormal cavernous artery structure. Four patients (11.4%) had extensive circular plaques in the tunica albuginea, limiting expansion of the cavernous body during erection, as shown by a constant cavernous body diameter of the affected side compared with an increasing diameter of the unaffected side during the progressive phases of erection. Patients with a constricting ring of plaques had persistent penile pain during erection as well as after injection during penile duplex sonography. Conclusions. Peyronie disease is caused by replacement of penile tunica albuginea tissue with inelastic scarring. One manifestation of Peyronie disease is painful erection. In patients with persistent erectile pain, we found circumferential inelastic scarring of the tunica albuginea. The findings of penile compartment syndrome on penile sonography may influence the urologist’s choice of surgical technique for treating Peyronie disease.

Key Words: compartment syndrome • Peyronie disease • plaques