title: Peyronie's disease plaque calcification--prevalence, time to identification, and development of a new grading classification.
abstract: BACKGROUND
  Peyronie's disease (PD) is a connective tissue disorder of the penis in which a fibrous scar in the tunica albuginea can result in multiple penile deformities.
  
  
  OBJECTIVE
  The study aims to investigate the prevalence and time to identification of plaque calcification (PC) in our PD patient population and whether stratification of calcification based on severity seen on ultrasound would serve as a predictor of treatment progression to surgery.
  
  
  METHODS
  A retrospective review of 1,041 men presenting with PD from 1993 to 2009 was performed. Eight hundred thirty-four underwent penile duplex ultrasound.
  
  
  METHODS
  PC was graded as: grade 1 (<0.3 cm), grade 2 (>0.3 cm, <1.5 cm), grade 3 (>1.5 cm; or ≥ 2 plaques >1.0 cm). A matched control group with noncalcified plaques (n = 236) was selected for comparison.
  
  
  RESULTS
  Two hundred eighty-four men (34%) were found to have PC noted on ultrasound, and 98 had fully documented dimensions of the PC. Forty-one percent were found to have grade 1, 28% grade 2, and 32% grade 3. When analyzed by grade and progression to surgery, 23% of grade 1, 32% of grade 2, and 55% of grade 3 patients had surgery. Those with grade 3 PC were more likely to undergo surgical intervention for PD (OR 2.28 95% CI 1.07-4.86) and more likely to undergo a grafting procedure than control patients (P < 0.0001).
  
  
  CONCLUSIONS
  Men with PC are not more likely to undergo surgery than those without PC (OR 0.95, 95% CI 0.58-1.57). PC is not uncommon, as it was found in 34% of our cohort. PC does not appear to be an indication of mature or stable disease, as it was identified by ultrasound in 37% of patients less than 12 months after onset of symptoms. Men with grade 3 PC have an increased likelihood of progression to surgical intervention and a higher likelihood of undergoing a grafting procedure.
authors.affiliation: Department of Urology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Laurence
authors.initials: L
authors.lastname: Levine
authors.forename: James
authors.initials: J
authors.lastname: Rybak
authors.forename: Christopher
authors.initials: C
authors.lastname: Corder
authors.forename: Michael Ryan
authors.initials: MR
authors.lastname: Farrel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000145:classification* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010411:Penile Induration / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D010413:Penis / Q000000981:diagnostic imaging / Q000601:surgery; D015995:Prevalence; D012189:Retrospective Studies; D018616:Ultrasonography, Doppler, Duplex; D055815:Young Adult
keywords: Calcification; Incidence; Mature Disease; Prevalence; Severity; Tunica Albuginea Deformity