title: Are sonographic characteristics associated with progression to surgery in men with Peyronie's disease?
abstract: OBJECTIVE
  Traditionally, diagnosis and treatment plans for Peyronie's disease have been based on history and physical examination. Penile ultrasound provides rapid, anatomical information to establish disease severity, and to monitor progression and response to medical therapy. We determined the relationship between ultrasound characteristics and progression to surgical intervention in men with Peyronie's disease.
  
  
  METHODS
  We conducted a retrospective cohort study of 518 patients with Peyronie's disease. Patients completed a Peyronie's disease specific questionnaire detailing medical history, health related behaviors and Peyronie's disease characteristics, and underwent sonographic evaluation of the penis. Measurements of subtunical calcifications, septal fibrosis, tunical thickening (tunica thickness greater than 2 mm) and intracavernous fibrosis were made. Progression to surgery was determined from the medical record.
  
  
  RESULTS
  In this cohort (mean patient age 53.8 years, range 20 to 78) 31% of patients had calcifications, 50% had tunical thickening, 20% had septal fibrosis and 15% had intracavernous fibrosis. Overall 25% of the cohort progressed to surgical intervention after an average followup of 1.25 years (range 0 to 7.6). Patients who underwent surgery were more likely to have subtunical calcifications present at the first clinic visit (OR 1.75, 95% CI 1.16-2.62). No other sonographic characteristics were associated with progression to surgery. After adjustment for age, marital status, degree of curvature, additional penile deformity, difficulty with penetration, ability to have intercourse and prior treatment for Peyronie's disease, calcifications were strongly associated with progression to surgery (OR 2.75, 95% CI 1.25-3.45).
  
  
  CONCLUSIONS
  In a large cohort of patients with Peyronie's disease the presence of sonographically detected sub-tunical calcifications during the initial office evaluation was independently associated with subsequent surgical intervention.
authors.affiliation: Department of Urology, University of California San Francisco, California 94143-1695, USA.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
authors.forename: Alan W
authors.initials: AW
authors.lastname: Shindel
authors.forename: Yun-Ching
authors.initials: YC
authors.lastname: Huang
authors.forename: Michael L
authors.initials: ML
authors.lastname: Eisenberg
authors.forename: Dana A
authors.initials: DA
authors.lastname: Weiss
authors.forename: Tom F
authors.initials: TF
authors.lastname: Lue
authors.forename: James F
authors.initials: JF
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D010411:Penile Induration / Q000000981:diagnostic imaging* / Q000601:surgery*; D012189:Retrospective Studies; D014463:Ultrasonography; D055815:Young Adult