153 The Use of Penile Computed Tomography Cavernosogram (CTC) in the Evaluation of Peyronie's Disease

Abstract

The evaluation of Peyronie’s Disease (PD) relies on patient history and physical exam. The clinical assessment of plaque size and location on exam is qualitative, is observer dependent and has been shown to be unreliable. Current AUA guidelines recommend an intracavernosal penile injection with or without penile color doppler ultrasound in the office. Advanced imaging techniques play a limited role. Intralesional collagenase is the only FDA-approved medical treatment for PD, yet the benefit of this therapy is highly dependent upon pre-treatment evaluation and appropriate patient selection. Therapeutic benefit has been disappointing. Recent studies have demonstrated the utility for Computed Tomography Cavernosography (CTC) in the evaluation of penile anatomy and erectile dysfunction. Its use in the anatomic evaluation of PD has not been investigated or reported. Evaluate the use of penile CTC in the pre-operative evaluation of men with Peyronie’s disease Men with documented PD who had undergone 3D CTC with concurrent intracavernosal injection (ICI) were identified from the medical record. Institutional protocol included use of Philips IQon Spectral CT scanner and an injection of varying dose of trimix (alprostadil, papaverine, phentolamine) in the proximal base of the penis. The medication dose was determined by pre-existing erectile function. The dose was repeated until a 3 out of 4 erection was achieved (adequate for penetration) or the maximum dose (1cc) had been administered. A 20-gauge angiocatheter was inserted into the left subcoronal corpora after injection of lidocaine for local analgesia. The penis was then manually inflated using a 50% mixture of iodinated contrast solution until maximum erection was achieved. 3D CT imaging was then obtained. A reversal dose of phenylephrine was administered if necessary, the catheter was removed, and a compressive dressing was placed. Images were processed using Philips software v4.7.5.43524.