Does Repeating Another Course of Intralesional Collagenase Clostridium Injections Improve Penile Curvature in Men with Peyronie’s Disease?
Intralesional injection of collagenase clostridium histolyticum (CCH) has been established as a non-surgical management option for Peyronie&[prime]s disease (PD). The treatment pathway for CCH injection involves four cycles, with two injections per cycle. Treatment regimens consisting of more than four cycles have yet to be adequately evaluated. Our goal was to assess whether repeating another course of CCH injections in men who wanted to avoid surgery may be beneficial.
We retrospectively reviewed all patients with PD who completed eight cycles of intralesional CCH injections for PD at our institution between 4/2014 and 7/2017. All patients had stable disease and penile curvature between 30-90°. Each treatment cycle consisted of two CCH injections separated by two days. The treatment cycles were separated by six week intervals. Patients were instructed to perform penile traction therapy and penile modeling throughout each treatment cycle. Penile curvature was measured prior to initiation of therapy and six weeks after completing the fourth cycle. If clinical improvement was not satisfactory, and if a new lesional target was able to be attained (due to a change in the maximal point of curvature), an additional course of CCH was offered if the patient was not interested in surgery. A curve assessment was performed again after completing the eighth cycle of CCH therapy. Paired t-test was used to compare penile curvature after four and eight cycles.
Overall, 13 patients were included in our analysis. The mean penile curvature prior to any treatment was 52.9° (SD±15.9). The mean penile curvature after four cycles of therapy was 43.7° (SD±3.58) (p=0.038), a 14.9% improvement. These patients then underwent an additional four cycles of CCH. The mean penile curve after eight cycles was 39.3° (SD±3.03) (p=0.162), an 8% improvement compared to the mean penile curvature after four cycles. The total curvature improvement after eight cycles was 23.3%. Four men (30.8%) went on to surgery, while nine men (69.2%) chose to continue non-operative management. Three (23.1%) patients developed penile hematomas >5 centimeters within the first four cycles and all were managed conservatively. There were no significant complications with the additional four cycles of CCH.
Providing the traditional four cycles of intralesional CCH offers a significant improvement in penile curvature for men with PD. Completing an additional four cycles, although safe, does not significantly improve penile curvature.