Administration of Collagenase Clostridial Histolyticum (Cch) for Peyronie's Disease.

Peyronie’s disease (PD) is a progressive wound-healing disorder highlighted by an inelastic fibrous scar in the tunica albuginea. Its etiology has been linked to a history of penile trauma and subsequent microvascular insults followed by extravascular activation of the fibrotic cascade. The most common clinical manifestation is a dorsal curvature and an associated palpable plaque. Subjective symptoms include painful erections, sexual dysfunction, and significant psychosocial burden. Options for non-surgical management of PD include penile stretching programs and devices, oral medications, and injectable agents (interferon-alpha 2B, verapamil). No single agent or modality has been shown to reliably alter fibrotic disease process resulting in modest and inconsistent benefits in a minority of men. Collagenase clostridium histolyticum (CCh) intralesional injection is Food and Drug Administration approved for adult men with PD with a palpable plaque and non-ventral curvature of at least 30 degrees at the start of therapy. CCh is a bacterially derived collagenase that cleaves the collagen triple-helix within the Peyronie’s plaque potentially leading to change in plaque and penile morphology. Each CCh injection cycle consists of two Peyronie’s plaque injections followed by an in-office penile modeling session. The patient may require up to four cycles of CCh to achieve maximal penile straightening. CCh is packaged in two vials. The first vial contains 0.9 mg of lyophilized CCh that requires reconstitution. The second vial is the diluent; a calcium dihydrate-containing solution that is required for activation of the CCh enzyme. Both vials should be removed from the refrigerator and allowed to rest at room temperature for 15 minutes prior to mixing. To reconstitute, 0.39 mL of diluent is injected into the vial containing lyophilized powder. This reconstituted solution of CCH can be kept for 1 hour at room temperature or refrigerated at 2–8°C for up to 4 hours.