Editorial Comment: Impact of the advent of collagenase clostridium histolyticum on the surgical management of Peyronie's disease: a population-based analysis

Abstract

After the 2013 FDA approval of collagenase clostridium histolyticum (CCH) what was its impact on the use of surgical management of Peyronie Disease (PD) in United State? Dr. Sukumar and cols. from Columbia University hypothesized that with the introduction of CCH, surgery as a primary treatment modality for PD would be used less often. The authors reviewed 547 men with PD registered in Statewide Planning and Research Cooperative System (SPARCS) that provides data on patients in the outpatient, inpatient, ambulatory, and emergency department setting in New York. All patients >18 years old with a diagnosis with PD who received surgical therapy (ST), defined as plaque excision/incision and grafting or plication, or injection therapy (IT) as a primary treatment between 2003 and 2016 were included. Over the study period, surgical management was used less often as the primary procedure with a concurrent increase in use of IT (P < .001). On multivariable modeling, patients more likely to receive IT as treatment for penile curvature were younger, of higher socioeconomic status and presented to a surgeon with a high volume practice. That trend should worry other countries were CCH could be approved? IMPRESS I and II data revealed that men treated with CCH showed a mean 34% improvement in penile curvature, representing a mean-9.3 ± 13.6 degree change per subject (p <0.0001) (1) after eight injections.

Surgical outcomes after collagenase Clostridium histolyticum failure in patients with Peyronie’s disease in a multicenter clinical study

“…As said, 5-year follow-up data from the IMPRESS I/II trials, suggested that patients undergoing CCH depicted significant improvements in terms of PC and satisfaction 6 . Vice versa, despite Sukumar et al reported that injection therapies such as CCH are increasingly displacing surgical management as the primary treatment option for PD 28 , many patients may have insufficient improvement of their PC after intraplaque CCH injections, with a consequent negative impact on their quality of life.…”