Review of Intralesional Collagenase Clostridium Histolyticum Injection Therapy and Related Combination Therapies in the Treatment of Peyronie's Disease (an Update)

Natale, Caleb; McLellan, David M.; Yousif, Ayad

doi:10.1016/j.sxmr.2020.01.005

Cited by 14 publications

(7 citation statements)

References 16 publications

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“…Surgical treatment for PD is most definitive but is reserved for those with stable disease. For patients with acute phase PD, some non-surgical and minimally invasive treatment options include L-citrulline, pentoxifylline, vitamin E, and intralesional interferon-α2b, verapamil, or hyaluronic acid (15,(18)(19)(20)(21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

Intralesional collagenase Clostridium histolyticum for acute phase Peyronie’s disease: a single-center, retrospective cohort study

Hu¹,

Sigalos²,

Walker³

et al. 2022

Transl Androl Urol

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Background: 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.Methods: 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.Results: 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).Conclusions: 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.

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Section: Introductionmentioning

confidence: 99%

Intralesional collagenase Clostridium histolyticum for acute phase Peyronie’s disease: a single-center, retrospective cohort study

Hu¹,

Sigalos²,

Walker³

et al. 2022

Transl Androl Urol

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“…Although pain during the procedure is one of the most common adverse effects reported by PD patients treated with CCH (Gelbard et al., 2013; Levine et al., 2015; Natale, McLellan, Yousif, & Hellstrom, 2020), the pre‐procedure anaesthesia is not standardized and there is no consensus regarding its use. Currently, there are no studies comparing the pain related to the CCH injection with and without previous dorsal penile nerve block.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of dorsal penile nerve block before collagenase of clostridium histolyticum injections in peyronie's disease patients: Results from a prospective pilot study

Rojo¹,

Gómez

Manfredi

et al. 2020

Andrologia

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Peyronie's disease (PD) is an acquired pathology characterized by the formation of fibrous plaques in the context of the tunica albuginea of the penis, with consequent development of penile deformities (Al-Thakafi & Al-Hathal, 2016). Although the epidemiological data are limited and inconsistent, different studies described an incidence of up to 5% in the general male population (La Pera et al., 2001; Lindsay et al., 1991), with peaks of up to 20.3% in selected subgroups (Arafa, Eid, El-Badry, Ezz-Eldine, & Shamloul, 2007). It affects males of all ages, being more prevalent in middle-advanced age (Schwarzer et al., 2001), but presenting a more aggressive course in younger patients (Taylor & Levine, 2007). It was related to multiple risk factors, being repeated micro-trauma during sexual intercourse the most accredited etiopathogenic theory (Bjekic, Vlajinac, Sipetic, & Marinkovic, 2006; Kadioglu et al., 2002). The natural history of PD is generally subdivided into two successive stages: one acute or inflammatory, with variable duration, followed by another chronic or stable. The acute phase is characterized by pain with erections and the presence of an inflammatory plaque that causes the associated malformations (curvature, shortening or narrowing). In the chronic stage, the inflammation decreases, pain

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“…Due to the rarity of these cases, there is no consensus on the management of penile fractures in patients after CCH injection. In the survey distributed to SMSNA attendees, about 67% of providers reported preferring surgical intervention in these cases, however other physicians have been leaning toward conservative management [56,58]. Some providers opt for a conservative approach if the patient is hemodynamically stable without suspicion of urethral injury but prefer to operate if the patient presents within 24 hours of injury [59].…”

Section: Corporal Rupture With Collagenase Clostridium Histolyticummentioning

confidence: 99%

Presentation, Management, and Outcomes of Penile Fractures

Pandher¹,

Pedrosa²,

Alwaal³

2022

JOMH

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Background: Penile fractures are due to a traumatic rupture of the penile tunica albuginea of the corpus cavernosum and may result from numerous etiologies. The purpose of our review is to describe the etiology, management, and outcomes of penile fractures. Methods: A literature review was performed. Results: The diagnosis of penile fractures is usually made clinically but can also be made with the assistance of ultrasound or MRI (magnetic resonance imaging) imaging when unclear. Cystoscopy should be performed when urethral involvement is suspected. Surgical management should be initiated promptly after the diagnosis, and within 24 hours of presentation. Surgical management can include the subcoronal or penoscrotal approach, although the penoscrotal approach is preferred when imaging confirms the location of the injury to be ventral and proximal, due to the reduced morbidity of this technique. Complications following penile fractures include erectile dysfunction, penile curvature, and voiding symptoms, but the incidence of complications is reduced if surgical intervention is performed promptly after fracture presentation. A rare cause of penile fractures is collagenase clostridium histolyticum injection, and these cases should predominantly be managed conservatively. Conclusions: Penile fractures can present in various ways and must be managed surgically and promptly after the diagnosis is made.

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Review of Intralesional Collagenase Clostridium Histolyticum Injection Therapy and Related Combination Therapies in the Treatment of Peyronie's Disease (an Update)

Cited by 14 publications

References 16 publications

Intralesional collagenase Clostridium histolyticum for acute phase Peyronie’s disease: a single-center, retrospective cohort study

Intralesional collagenase Clostridium histolyticum for acute phase Peyronie’s disease: a single-center, retrospective cohort study

Efficacy and safety of dorsal penile nerve block before collagenase of clostridium histolyticum injections in peyronie's disease patients: Results from a prospective pilot study

Presentation, Management, and Outcomes of Penile Fractures

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