Penile Curvature

Both Peyronie’s Disease and congenital penile curvature can be found in adolescents and young adults and therefore the age of onset is not a good criterion to distinguish between the two conditions. However, in patients with congenital penile curvature there is no palpable lump, which is instead indicative of Peyronie’s Disease.  Also, while most congenital curvatures are ventral, in most patients with Peyronie’s Disease the penis bends upward. Waist deformities are also absent in patients with congenital curvature, which tend to be more gentle and harmonic than the one of patients with Peyronie’s Disease.

While erectile dysfunction is a common finding in patients with Peyronie’s Disease, most patients with congenital penile curvature have adequate erections, as there is no association between cardiovascular risk factors and congenital penile curvature. To render the situation more confusing, some of the patients with congenital penile curvature may eventually develop Peyronie’s Disease later in life and therefore both conditions may coexist.

The diagnosis of congenital penile curvature is based on history taking and on the examination of the patient. Most patients notice the curvature during adolescence. Examination of the penis will demonstrate a soft, elastic tunica albuginea and the absence of the indurated lumps typical of Peyronie’s Disease.

Deformity can be assessed only during erections, when the tunica albuginea of the penis is stretched to its maximum capacity. Self-photography of the erect penis can be a useful tool to identify the nature of the deformity. However, this can underestimate the exact tridimensional extent of the curvature, as the picture is by definition bi-planar. Also, an incomplete erection will make the deformity appear less pronounced. Alternatively, an artificial erection can be induced in the office with the administration of a vasoactive medication. This allows the surgeon to assess more precisely the tridimensional extent of the curvature and better plan the treatment options. Doppler ultrasound scan can be extremely useful to rule out the presence of plaques in the equivocal cases.

In patients with congenital ventral penile curvature it is very important to examine the urethral meatus and the distal urethra as congenital ventral penile curvature may be associated with anomalies of the penile urethra.