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abstract

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Novel injection method using a Collagenase Clostridium histolyticum in Peyronie’s Disease

Zotter, Z1; Papp, G1; Kovács, G1

1: Hunagrian Defense Forces, Medical Center, Hungary

Introduction and objectives: Collagenase Clostridium histolyticum (CCH) is the first licensed minimally invasive treatment option for men with Peyronie's disease (PD) with palpable plaque and curvature of at least 30 degrees. We evaluated the efficacy and safety of CCH using a novel modified injection method that aimed to reach a broader surface of the PD plaque.

Materials and methods: A prospective study of 34 patients with PD who had treatment with CCH at a single center using a new modified injection method between April 2014 and August 2017. Penile curvature was greater than 30 degrees in all patients, which was documented by auto-photography using the Kelami technique. The International Index of Erectile Function (IIEF) and Peyronie's Disease Questionnaire (PDQ) were completed at baseline and 6 weeks after the last treatment cycle. Thirty-two of the 34 patients received 2 treatment cycles (4 injections with 0.58 mg of CCH), one patient 3 treatment cycles and one patient 4 treatment cycles. We applied two different injection methods. In smaller plaques CCH was injected using a branching technique, longer plaques were injected in a longitudinal geometrical crossed pattern. Investigator modeling was performed after each treatment cycle and the patients were instructed to continue at-home penile stretching and modeling. Vacuum therapy was applied twice daily starting 3 days after investigator modeling until the following cycle.

Results: The mean (range) penile curvature at baseline was 56.21 (35-110)°. All the patients in the study had an improvement in the angle of curvature by a mean (range) of 25.45 (9-55)° or 47.6 (20-83)% from baseline at 6 months. The mean (range) curvature was 30.45 (7-78)° (paired-samples t-test, p < 0.0001) after CCH treatment. There was an improvement in each of the IIEF questionnaire domains and all three PDQ. CCH was well tolerated by all patients with only mild to moderate and transient local adverse events. Penile fracture was not reported following treatment.

Conclusion: This novel CCH injection method using a shortened protocol is safe and effective. The results to date are comparable to those of the clinical trials using eight CCH injections.

Disclosure:

Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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