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• September 2007
• April 2007
• February 2007
• November 2006
• September 2006
• May 2006
• March 2006
• January 2006
• December 2005

The case of the month

September 2007 case of the month

A 55 years old male patient presents to an Andrology outpatient unit with penile pain and dorsal curvature (30-40 degrees) during erection lasting for 3 months (figure 1). The patient reports increasing pain everyday. His erections are normal and medical history was free for other concomitant disease. Physical examination revealed a dorsal palpable nodule (approximately 2x2cm) on the penis (Case provided by Prof. Emre Akkus, Instanbul, Turkey, emreak@istanbul.edu.tr)

Question 1
What would be the diagnostic work-up in this patient?

1. Autophotography: 34%
2. Intracavernous injection of vasoactive agents: 9%
3. Color Doppler Ultrasonography: 23%
4. Penile MRI: 27%
5. Dynamic Infusion Cavernosometry and Cavernosography (DICC): 7%

Comments:

An autophotography is necessary to document the penile curvature. Alternatively, an intracavernous injection of vasoactive agents could be used to document this curvature in the office. This patient has normal erectile function, so it is not necessary to include color Doppler ultrasonography and DICC in the diagnostic work-up. A duplex ultrasonography is able to provide information on the size and location of the plaque and it is useful compare the results of the possible treatment. Furthermore, it can provide information on the calcification status of the plaque that is important to select between conservative and surgical treatment.

Question 2
How would you manage this patient?

1. No treatment-watchful waiting: 4%
2. Medical therapy (colchicine, vitamin E, tamoxifen, POTABA, etc): 48%
3. Plication surgery: 23%
4. Incision and vein patch surgery: 21%
5. Penile prosthesis: 4%

Comments:

This patient experiences pain during erection suggesting that the disease is not yet stabilized. My choice would be to start oral treatment with Colchicine 2mg/day approximately 3-6 months depending on decrease in plaque size and pain during erection and reevaluate the patient at the end of 3 months and then 6 months. Surgery should be considered only when the curvature is stable for at least 6 months.