Whenever a test has been ordered the physician (and the patient) should ask themselves how the results of the test will alter the plan of treatment. If the answer is “not much” then the test is probably not indicated. Over history, numerous imaging studies have been employed including x-rays, ultrasound and MRI. X-rays have been used to assess for calcification. Calcification usually indicates the presence of late stage disease. The x-ray can show calcium deposits. However, calcification is often not complete, that is that it is in one part of the plaque and not throughout the entire scar. Furthermore, the most significant calcification can be diagnosed by an experienced urologist by plain palpation (feeling the plaque). When MRI became readily available there was great interest in using it in the imaging of men with Peyronie’s disease. There is no doubt that it gives beautiful pictures however, it is rare that such pictures will change how the physician plans to proceed.
Ultrasound of the penis can be used to examine the scar, its size and calcification, but can also be used to evaluate penile blood flow before surgical reconstruction. Some authorities are interested in plaque volume, however others (including myself) are less interested in this and more interested in functional factors such as degree of curvature and ability to have sex. However, I would agree that all men undergoing penile reconstruction surgery for Peyronie’s disease should have an assessment of their penile blood flow beforehand as this may impact upon the choice of the procedure for the individual patient. The bottom line is that except for the preoperative patient, imaging is not absolutely necessary although individual physicians may perform such imaging in their practices.