Intralesional collagenase Clostridium histolyticum for acute phase Peyronie’s disease: a single-center, retrospective cohort study
Ming-Yeah HuJohn T. SigalosDyvon T. WalkerMichelle K. LiDar A. YoffeNeilufar ModiriThomas W. GaitherAlvaro SantamariaKeith V. RegetsSriram V. EleswarapuJesse N. Mills
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Abstract:
Peyronie's disease (PD) can be subdivided into acute and chronic phases. Intralesional collagenase Clostridium histolyticum has been shown to improve curvature in the chronic phase. Initial clinical trials excluded patients in the acute phase from treatment. Recent studies show comparable results among men in the acute phase. The definition of acute phase varies among existing studies, but it is generally understood to last 12-18 months and is accompanied by penile pain and progression of deformity. We sought to evaluate the safety and efficacy of intralesional collagenase injection therapy during the acute phase of PD using multiple definitions of the acute phase.All men receiving intralesional collagenase for PD from October 2015 through December 2020 at a single academic institution were retrospectively assessed for patient demographics and comorbidities, pre- and post-treatment curvature, and adverse events. Two definitions of acute phase were used: (I) acute phase duration ≤6 months, chronic phase duration >6 months; and (II) acute phase duration ≤12 months with penile pain, chronic phase duration >12 or no penile pain.Of 330 patients identified, 229 underwent intralesional collagenase treatment with pre- and post-treatment erect penile goniometry. 65 (28%) met criteria for definition 1 of acute phase, 37 (16%) met criteria for definition 2, and 76 (33%) met criteria for either. Percent change in penile curvature was not significantly different between acute and chronic phases using definition 1 (16.0% vs. 16.6%, P=0.89), definition 2 (19.9% vs. 15.7%, P=0.43), or either (16.5% vs. 16.3%, P=0.96). The rates of development of bruising, swelling, hematoma, or corporal rupture were not significantly different between the acute and chronic phases under either definition (all P>0.05).This single-center, retrospective cohort analysis suggests that intralesional collagenase is both safe and effective for the treatment of men with acute phase PD. Limitations exist inherent to retrospective review, since many men did not return for post-treatment goniometry, possibly skewing our cohort toward incomplete responders. Prospective, randomized studies will be required to confirm these findings.Keywords:
Penile curvature
Peyronie's disease, characterized by the formation of a fibrous plaque within the tunica albuginea of the corpora cavernosa, has long caused sexual dysfunction. Plication surgery has allowed a simple technique to correct the penile curvature caused by Peyronie' s disease. The 16-dot plication technique corrects the penile curvature with a high level of patient satisfaction and yet can be performed under local anesthesia. Slight adjustments can be made during the procedure, which allows greater precision toward penile strengthening. The 16-dot penile plication procedure has an 85% long-term success rate for achieving a straight erection by patient reporting. Minimal complications are reported, with penile shortening (0.5–1.5 cm) reported at 41%. With a mean operative time of 45 min and the ability to perform the procedure under local anesthesia, the 16-dot plication procedure is an important tool for the urologist for treatment of Peyronie's disease.
Penile curvature
Tunica albuginea (penis)
Local anesthesia
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Many men with Peyronie’s disease are embarrassed and choose to suffer in silence rather than get help. Peyronie’s disease can be a physically and psychologically devastating. This case report presents a successful correction of penile curvature using platelet rich plasma (PRP) treatment in an office setting.
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Peyronie's disease is caused by collagen deposits in the tunica albuginea of the corpus cavernosum following microtrauma. Symptoms may include a combination of penile curvature, a palpable plaque, painful erections and erectile dysfunction. Peyronie's disease can have a major impact on the quality of life. In the course of the disease two phases can be discerned. In the first, active phase there is penile curvature with painful erections. The second, stable phase is characterised by painless curvature of the penis. Treatment in the active phase is conservative and supportive. Surgical treatment is useful only in the stable phase and may consist of penile plication surgery or penile graft surgery.
Tunica albuginea (penis)
Penile curvature
Microtrauma
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(Background) To evaluate the natural history of Peyronie's disease and to determine the suitable time for surgical treatment, we investigated changes of clinical findings of the disease over time.(Patients and Methods) We evaluated changes of plaque size, penile curvature and erectile dysfunction in 10 patients with Peyronie's disease. The mean follow-up period was 36.8 months.(Results) At the first examination, the mean plaque size of patients with erectile dysfunction was larger than that of those without erectile dysfunction, suggesting a positive association between size and erectile function. There was no significant relationship between plaque size and penile pain or penile curvature. The mean size of plaques decreased significantly compared with that at the first examination (p<0.05). However, penile curvature, pain and erectile dysfunction perisisted during the follow-up peirod in all but one patient, who showed improvement of penile curvature.(Conclusion) These results suggest that we may recommend a shorter observation period until surgery than we have done for some patients who want to be surgically treated.
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Tunica albuginea (penis)
Penile curvature
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Penile curvature
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INTRODUCTION Erectile dysfunction (ED) has been defined as the consistent or recurrent inability of a man to attain and/or maintain a penile erection sufficient for satisfying sexual performance. Consistency is an important aspect of the definition of ED. Erectile difficulties must be reported to occur on a consistent or recurrent basis in order to qualify for the diagnosis of ED. A three-month minimum duration is generally accepted for establishment of the diagnosis. In some instances of trauma or surgically induced ED (e.g., postprostatovesiculectomy or postcystectomy), the diagnosis may be confirmed prior to three months. Although ED is a benign disorder, it is closely related to physical and psychosocial health, and has an essential influence on the quality of life of both patients and their partners. Clinically, the diagnosis of ED is primarily based on patient's self-report. The diagnosis may be supported by objective testing (or partner's report), nevertheless these measures cannot displace the patient's self-report in classifying the disorder. The necessary reliance on patient's reports implies that cultural factors and patient-physician communication and relation will be important determinants in defining and diagnosing the disorder.
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