The Use of Penile Computed Tomography Cavernosogram in the Evaluation of Peyronie's Disease: A Pilot Study.

Background: Clinical assessment of Peyronie disease (PD) is unreliable and difficult to reproduce. Aim: To assess the utility of the computed tomography cavernosography (CTC) in evaluating the penile functional abnormalities of PD. Methods: Men were placed in the Philips IQon Spectral CT scanner (Phillips, Cambridge, MA, USA) in the supine position. The penis was injected with trimix (papaverine 30 mg/cc, phentolamine 2 mg/cc, and prostaglandin 20 mcg/cc) in the left proximal base using a 27-gauge syringe. Clinical effect was assessed after 5 minutes. If penile erection was less rigid than adequate for penetration, the dose was repeated until a satisfactory result was achieved. A subcutaneous injection of 1% lidocaine for local analgesia was then injected into the left subcoronal corpora. After the maximum erection was obtained, a 20-gauge angiocatheter was inserted into the anesthetized area. The angiocatheter was connected via intravenous tubing to a 60-cc luer lock syringe of 50% mixture of iodinated contrast in normal saline. The penis was manually inflated until maximum erection was achieved as per the patient's report. The patient then underwent computed tomography scan. Upon completion, a reversal dose of phenylephrine was administered through the angiocatheter. The angiocatheter was then removed, and a penile compression dressing was applied. Outcomes: Images were assessed for degree of curvature, presence of corporal involvement, and location of corporal involvement. Results: 63 men underwent CTC. The average age was 57 years (95% confidence interval [CI]: 54, 60). Duration of PD was 5.2 years (95% CI: 3, 7). Diabetes and hypogonadism were found in 15% and 50% of men, respectively. The primary angulation was 52 (95% CI: 40, 60). Multiple angulations were found in 80% of men with 3 or more degrees of angulation in 14%. Bilateral corporal involvement was found in 87%, and proximal involvement was found in 64%. Dorsal/dorsolateral, ventral/ventrolateral, lateral, and hourglass/corkscrew deformities were seen in 58%, 23%, 12%, and 7%, respectively. Average dose of trimix (mg-papaverine + mgphentolamine + mcg-PGE-1), contrast dose, and radiation dose per scan were 26 (22, 31), 55 cc (47, 63), and 770 mGy*cm (902, 638), respectively. Clinical Implications: CTC may reveal additional information regarding the anatomy of the penis in men with PD which is not readily available by existing methods of evaluation. Strengths & Limitations: We evaluated a small cohort of men with CTC which allowed for detailed visualization and assessment of their PD. This study is limited by the small sample of patients, retrospective nature, and absence of clinical outcomes which will require further study in the future. Conclusion: The CTC may be useful in clearly defining the corporal abnormalities in men with PD. Copyright (C) 2020, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.