Ultrasound predictive factors for efficacy and safety of the use of Collagenase Clostridium Histolyticum (CCH) in the treatment of Peyronie's disease (PD): Impact of patient´s selection
Fernández-Pascual, E1; Martínez-Salamanca, JI1; Cerezo, E1; Minaya, J1; Carballido, J1
1: LYX Institute of Urology, Spain
Introduction: The use of CCH has become a therapeutic option in the non-surgical management of PD. The discordance in the efficacy of CCH among patients prompted us to look for ultrasound and clinical findings that may allow us to select the best candidates for this therapy.
Material and methods: Between June 2014 and September 2017, we evaluated and treated 87 patients with stable PD curvature. Collection of clinical data (PDQ, IIEF-5, degree of curvature) and a Doppler-US of the penis by a dedicated radiologist was performed to every patient. Several data were obtained (size and thickness of plaque, septal involvement, embedding of dorsal arteries, subglandar involvement, plaque calcification among others). Our protocol consisted of 3-month cycles with two CCH injections for the first 2 weeks, following by modeling the next week, and two months of "Triple Therapy" - tadalafil 2.5/5mg daily, pentoxifylline 400mg twice a day and 4-6 hours of penile traction therapy. The cohort mean age was 51.6 years (SD 9.5) with a mean curvature of 47.9º (SD 15.3), 67.8% of them with dorsal curvature and 33.2% dorso-lateral.
Results: In the multivariate analysis, we demonstrate the relationship between the success of the therapy (defined as improvement of ≥10º per cycle) and: the absence of calcifications (p=0.041), the absence of septum involvement (p=0.019), minor scores in PDQ (p=0.006), and smaller sizes and thicknesses of the plaque (p=0.02 and p=0.017). No clinical or ultrasound parameters were associated with an increased risk of complications.
Conclusions: The use of penile Doppler-US in conjunction with clinical parameters can help us to predict the efficacy of CCH treatment and to select suitable patients for this therapy.
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