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

Abstract

In the present study we aimed to investigate the surgical outcomes of patients with persistent penile curvature (PC) after Collagenase Clostridium histolyticum (CCH) intraplaque injections. Data from 90 patients with persistent PC after CCH in a multicentre study from 6 andrological centres were retrospectively reviewed. Three standardized surgical techniques were performed. Group 1: plaque incision grafting (PIG) with penile prosthesis implant (PPI); Group 2: PIG without PPI; Group 3: Nesbit technique. Hospital stay, operative time, postoperative complications and PC persistency/recurrence (> 20°) were evaluated. Overall satisfaction and functional outcomes were assessed through International Index of Erectile Function-Erectile Function (IIEF-EF), Peyronie’s Disease Questionnaire (PDQ), Female Sexual Function Index (FSFI) administered pre and 3 months postoperatively. Of all, 25 (27.8%) patients received grafting procedure + PPI (Group 1), 18 (20.0%) patients belonged to Group 2, and 47 (52.2%) to Group 3. Bovine pericardium graft and collagen fleece have been used in in 22 (51.2%) and 21 (48.8%) patients, respectively. Median penile length after surgery was 13.0 cm (IQR 12.0–15.0). After surgery, Group 1 showed higher increase in penile length after surgery and better improvements in terms of PDQ-PS. In contrast, both IIEF-EF and FSFI scores did not differ among groups. Overall, 86 (95.6%) did not report any complication. 4 (4.4%) patients had PC recurrence; of those, 2 (8.0%), 1 (5.6%) and 1 (2.1%) cases were observed in Group 1, Group 2 and Group 3, respectively. In case of persistent PC after CCH, surgical correction by grafting with or without concomitant PPI or Nesbit technique emerged as a technically feasible, effective and safe procedure, with no significant postoperative complications.

Penile reconstruction: An up-to-date review of the literature

“…This paper focusses on the surgical corrective measures, although it is worth noting that treatment with CCh is often sought out first due to its non-invasive nature. In fact, in a 2017 survey, only 18% of men chose surgery at any point throughout their disease course [ 49 ]. Overall efficacy for CCh and penile plication surgery varied, with estimated rates reported at 49.5% and 79–100%, respectively [ 1 , 49 ].…”

“…In fact, in a 2017 survey, only 18% of men chose surgery at any point throughout their disease course [ 49 ]. Overall efficacy for CCh and penile plication surgery varied, with estimated rates reported at 49.5% and 79–100%, respectively [ 1 , 49 ].…”

Pathological Significance of Macrophages in Erectile Dysfunction Including Peyronie’s Disease

“…Various novel treatment strategies and agents have been suggested and used for PD [ 124 , 138 , 139 , 140 , 141 ]. Furthermore, several studies have analyzed the usefulness of treatments according to disease phases [ 140 , 141 , 142 ].…”