Janusz Tyloch, Zbigniew Wolski
- Klinika Urologii Ogólnej, Onkologicznej i Dziecięcej CM w Bydgoszczy UMK w Toruniu
Introduction. Peyronie’s disease is characterized by formation of hardened scar and fibrous tissue in the tunica albuginea, septum and corpora cavernosa of the penis, typically resulting in the painful bend during erection, which makes sexual intercourse difficult. The hardening develops slowly, resulting in a plaque or tough “cord”, palpable dorsally from the urethra. Proper evaluation of the plaque’s location and size is important in the choice of treatment method and in the evaluation of the effects of instituted treatment. New generation ultrasound scanners enable to obtain three-dimensional images and thus make the evaluation of the scanned organ more accurate.
Objectives. The aim of this study was to present the examination methods, indications and advantages of three-dimensional ultrasound in the diagnosis of Peronie’s disease.
Materials and methods. Ultrasound scanning was performed in two patients with Peyronie’s disease. An indication for the examination involved palpable plaques in the tunica albuginea of the penis. The scanning was carried out with a linear transducer (ultrasonic wave frequency of 12 MHz) positioned transversely to the long axis of the penis and then moved from the root of the penis towards the glans penis. During movement of the transducer, single ultrasound images are acquired and arranged to give an appearance of a cube. Following the examination, this set of images is computer processed.
Results. We obtained the ultrasound images, encoded as “volumetric units”, or voxels, and arranged to form a cube, which was later computer-processed, using a specially designed computer program. Thus, in addition to traditional longitudinal and transverse views, we were able to obtain also a coronal view. In patients with Peyronie’s disease, this third view is of great importance since it allows for visualization of the whole plaque. Careful image analysis performed after the examination, and not in the patient’s presence, allowed to identify other, smaller plaques which were not observed prior to examination.
Conclusions. 1. New method of ultrasound diagnosis allows for more accurate evaluation of pathologic changes in the tunica albuginea of the penis in Peyronie’s disease. 2. Final evaluation involving analysis of obtained images is done after the examination and not in the patient’s presence. 3. Examination time is shortened when compared with two-dimensional ultrasound.