Duplex ultrasonography detects clinically significant anomalies of penile arterial vasculature affecting surgical approach to penile straightening.

Objectives: To determine the frequency of aberrant penile arterial anatomy in men with Peyronie's disease (PD) and the potential impact on the surgical approach to penile straightening.

Methods: A retrospective analysis of 63 consecutive men undergoing penile duplex ultrasonography in preparation for penile straightening surgery was performed. They were compared with a group of 61 men with erectile dysfunction (ED) undergoing penile duplex ultrasonography during the same period.

Results: Arterial anomalies distal to the pubic symphysis were noted in 44% of men with PD and 46% of men with ED. The most common anomaly observed was crossing cavernosal arteries seen in 37% of the men with PD and 39% of the men with ED. Distal perforators of the dorsal artery supplying the cavernosal bodies were observed in 10% and 8% of the men with PD and ED, respectively. No difference was found in the overall frequency or type of arterial anomalies between the two groups.

Conclusions: Men with PD have a high prevalence of arterial anomalies, including distal perforating arteries. Their preoperative evaluation should include duplex ultrasonography with delineation of the penile arterial anatomy. This will aid in surgical planning and potentially prevent maneuvers that may adversely affect the cavernosal blood supply and place the patient at risk of postoperative ED.