Multi-institutional prospective analysis of intralesional injection of collagenase clostridium histolyticum, tunical plication and partial plaque excision and grafting for the management of Peyronie’s Disease
Yafi, FA1; DeLay, KJ2; Diao, L3; DeYoung, L4; Talib, R4; Brock, G4; Hellstrom, WJ2; Hatzichristodouldou, G5
1: University of California Irvine, United States; 2: Tulane Univesity, New Orleans, USA; 3: Tulane University, New Orleans, USA; 4: University of Western Ontario, London, ON, Canada; 5: Julius-Maximilians-University of Würzburg, Würzburg, Germany
Objectives: Intralesional injection of Collagenase Clostridium Histolyticum (CCH) is the only Food and Drug Administration approved non-surgical intervention for the management of Peyronie’s disease (PD). We sought to prospectively compare the outcomes of CCH and two commonly performed surgical interventions (tunical plication [TP] and partial plaque excision and grafting [PEG]) in patients with PD.
Materials and methods: Between 6/2015 and 1/2017, 57 patients with PD and dorsal, dorsolateral and/or lateral penile curvatures between 30 and 90 degrees were included in this study. Patients with ventral curvature, hourglass deformity, and previous surgery for PD were excluded. All patients completed questionnaires and underwent penile measurements and penile vascular studies prior and after completion of treatment and were followed for at least 6 months.
Results: CCH was performed in 18 patients, TP in 14 and PEG in 25. The median follow-up for the whole cohort was 12 months (6-28). Mean pre-treatment curvatures were 65.5º (CCH), 75.7º (TP) and 75.2º (PEG), p=0.060. Mean change in curvature after treatment was 23.3º (34.4%) for CCH, 72.0º (92.2%) for TP and 71.8 º (94.9%) for PEG, p<0.001. Mean pre-treatment IIEF-5 scores were 16.1 (CCH), 14.7 (TP) and 18.4 (PEG), p=0.074; and the mean change in IIEF-5 scores was +5.7 for CCH, +4.9 for TP and +2.2 for PEG, p=0.395. Mean penile length change was -0.2cm for CCH, -1.0cm for TP and +0.9cm for PEG, p<0.001. Mean change in PDQ bother score was -7.0 for CCH, -3.3 for TP and -14.4 for PEG, p<0.001. Three patients in the CCH group underwent uneventful subsequent TP.
Conclusions: Surgical options are associated with superior curvature correction. CCH is an effective and safe first option for motivated patients who would like to avoid surgery. PEG is associated with a small stretched penile length gain.
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