title: Nonpalpable scarring of the penile septum as a cause of erectile dysfunction: an atypical form of Peyronie's disease.
abstract: BACKGROUND
  Men with nonpalpable isolated septal scars (ISS) identified with color duplex ultrasonography (CDU) comprise a group of previously unrecognized patients with wide-ranging sexual concerns.
  
  
  OBJECTIVE
  We aim to identify the clinical characteristics of patients presenting with this atypical form of Peyronie's disease characterized by the absence of palpable deformity.
  
  
  METHODS
  Of 482 consecutive patients who presented to a tertiary care erectile dysfunction (ED) clinic and underwent CDU after satisfying inclusion criteria, 27 (5.6%) men with nonpalpable ISS and no dorsal or ventral plaque were identified.
  
  
  METHODS
  International Index of Erectile Function (IIEF), CDU, and clinical characteristics.
  
  
  RESULTS
  The median age of the men with nonpalpable ISS was 49 years. The length of time from onset of symptoms to presentation was 22 months, and the pretreatment IIEF score was 14. The remaining 455 men who underwent CDU were of similar age (48 years) but had a markedly lower IIEF score of 9.5 (statistical median). ISS patients presented with decreased penile rigidity (20), penile shortening (13), chronic pain with erection (13; mean 33 months), and the inability to maintain an erection (7). Fourteen men had failed phosphodiesterase-5 inhibitor therapy, and four reported unsatisfactory results. Management options included retrial with oral agents, intracavernous pharmacotherapy, verapamil injections, and surgery.
  
  
  CONCLUSIONS
  The clinician should be suspicious for nonpalpable ISS in men with sexual concerns who present with decreased penile rigidity, length loss, and chronic pain with erection. Our findings support the use of CDU for this patient group, particularly when previous treatment has failed, because men with ISS had a greater likelihood of having no palpable deformity or curvature and ongoing penile pain.
authors.affiliation: Department of Urology, University of California, San Francisco, CA;. Electronic address: abella@urology.ucsf.edu.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Bella
authors.affiliation: The Department of Surgery, Division of Urology, St. Joseph's Health Center, The University of Western Ontario, London, Canada.
authors.forename: Alp
authors.initials: A
authors.lastname: Sener
authors.affiliation: The Department of Surgery, Division of Urology, St. Joseph's Health Center, The University of Western Ontario, London, Canada.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Foell
authors.affiliation: The Department of Surgery, Division of Urology, St. Joseph's Health Center, The University of Western Ontario, London, Canada.
authors.forename: Gerald B
authors.initials: GB
authors.lastname: Brock
mesh_terms: D000328:Adult; D007172:Erectile Dysfunction / Q000000981:diagnostic imaging* / Q000209:etiology; D005355:Fibrosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010411:Penile Induration / Q000000981:diagnostic imaging* / Q000473:pathology*; D010413:Penis / Q000000981:diagnostic imaging* / Q000473:pathology*; D018615:Ultrasonography, Doppler, Color