Isolated septal fibrosis or hematoma--atypical Peyronie's disease?
OBJECTIVE
Classically Peyronie's disease presents with penile curvature and/or pain, and is associated with a palpable penile plaque. We frequently examine patients with suspected Peyronie's disease ultrasonographically and have noted a subset of patients in whom we could identify only a circumscribed septal lesion. We identified characteristics of these patients.


METHODS
Of our series of approximately 650 patients with Peyronie's disease 47 were identified with these lesions.


RESULTS
Of the 47 patients 22 presented with penile curvature with or without accompanying or preceding pain. Of the 47 patients 17 had a significant history of trauma, although only had the classic stigmata of penile fracture. A total of 16 patients had no history of curvature, 7 presented with only penile shortening or focal lack of rigidity and 5 were incidentally found to have lesions during assessment for other complaints. Three patients presenting after trauma were noted to have septal liquefied hematomas, which we aspirated under ultrasound guidance. Followup ultrasound revealed minimal septal thickening. In 1 of these patients the hematoma was adjacent to more typical-appearing septal fibrosis.


CONCLUSIONS
We theorize that these hematomas are due to septal fractures and may represent a forme fruste or possibly a precursor lesion of more typical septal fibrosis. Ultrasonographic evaluation may allow earlier identification and treatment of occult septal injuries or lesions and prevent subsequent fibrosis and its associated symptoms.
Brant
William O
WO
Department of Urology, University of California-San Francisco, San Francisco, California 94143-0738, USA. panditah@hotmail.com
Bella
Anthony J
AJ
Garcia
Maurice M
MM
Tantiwongse
Kavirach
K
Dean
Robert C
RC
Lue
Tom F
TF
D000328:Adult; D005355:Fibrosis / Q000000981:diagnostic imaging; D006406:Hematoma / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010409:Penile Diseases / Q000000981:diagnostic imaging*; D010411:Penile Induration / Q000000981:diagnostic imaging*; D010413:Penis / Q000000981:diagnostic imaging* / Q000473:pathology*; D014463:Ultrasonography