The Influence of Indentation Deformity on Outcomes With Intralesional Collagenase Clostridium Histolyticum Monotherapy for Peyronie's Disease

Ziegelmann, Matthew; Heslop, Daniel; Houlihan, Matthew; Bajic, Petar; Helo, Sevann; Trost, Landon; Köhler, Tobias

doi:10.1016/j.urology.2020.01.035

Cited by 15 publications

(5 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is in keeping with another recent review which included observational studies as well [73]. Interestingly many observational "real world" postapproval studies [74][75][76] have shown intralesional CCH to be of benefit in acute phases of PD, but these findings are yet to be confirmed in RCTs. Intralesional interferon, verapamil and hyaluronic acid have a limited evidence base and are currently cannot be recommended for treatment.…”

Section: Discussionsupporting

confidence: 80%

A systematic review of non-surgical management in Peyronieʼs disease

et al. 2022

View full text Add to dashboard Cite

The efficacy of many non-surgical treatments for Peyronie’s disease is unclear. This systematic review aims to critically assess the currently available options and provide a recommendation for treatment based on this. A systematic literature search utilising the Medline (Pubmed), Embase, global health and Cochrane library databases was conducted up to May 2021. All randomised controlled trials assessing non-surgical treatment modalities for Peyronie’s Disease were included. Individual study risk of bias was evaluated using the Cochrane tool and GRADE was used to assess evidence strength. Outcome measures were the change in penile curvature (degrees), plaque size (volume or size), International Index of Erectile Function score, pain scores and change in penile length. Prospero registration number: CRD42017064618. Amongst the 5549 articles identified, 41 studies (42 reports) were included. Seven different oral treatment options including vitamin E supplementation showed evidence for improving outcomes such as penile curvature and plaque size. Of the intralesional treatments, Collagenase Clostridium Histolyticum showed evidence for improving penile curvature (Range: 16.3–17 degrees, moderate level certainty of evidence). Intralesional Interferon demonstrated some improvement in curvature (Range: 12–13.5 degrees), plaque size (Range: 1.67–2.2 cm2) and pain, whilst intralesional calcium channel blockers such as Verapamil showed variable evidence for changes in the plaque size and pain. Extracorporeal Shockwave Therapy consistently demonstrated evidence for improving penile pain in stable disease, and two mechanical traction devices improved curvature. Iontophoresis, topical medications, and combination therapies did not demonstrate any consistent improvements in outcome measures. Intralesional options demonstrate the best potential. Overall, results varied with few high-quality randomised trials present.

show abstract

Section: Discussionsupporting

confidence: 80%

A systematic review of non-surgical management in Peyronieʼs disease

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Sixty‐four per cent reported subjective improvement of deformity 25 . Ziegelmann et al also found a mean improvement in curvature of 19° following treatment with CCH 26 . Anaissie et al retrospectively reviewed satisfaction of patient and partner after CCH treatment with a questionnaire.…”

Section: Discussionmentioning

confidence: 99%

“…25 Ziegelmann et al also found a mean improvement in curvature of 19 following treatment with CCH. 26 Anaissie et al retrospectively reviewed satisfaction of patient and partner after CCH treatment with a questionnaire. They included 24 patients, 16 patients reported overall satisfaction of treatment and 17 partners were satisfied with the treatment.…”

Section: Complicationsmentioning

confidence: 99%

Improvement in the ability to have sex in patients with Peyronie's disease treated with Collagenase Clostridium histolyticum

et al. 2022

View full text Add to dashboard Cite

Objective To describe the results of intralesional Collagenase Clostridium histolyticum (CCH) treatment in patients with Peyronie's disease (PD) in real‐world setting. PD is characterized by curvature of the erect penis caused by fibrotic tissue in the tunica albuginea. Patients and methods Patients with stable PD and curvature of 30° to 90° were prospectively enrolled. CCH injections were initially given using a scheme of four cycles of two injections within 48–72 h every 6 weeks. Later using a modified scheme of three injections every 4 weeks, combined with a vacuum erection device (VED) twice daily. All patients were requested to take pictures of the erect penis prior to and following treatment, from above and laterally. Curvature was measured by three independent researchers based on the provided pictures using a goniometer. Furthermore, patients filled in the Peyronie Disease Questionnaire‐NL (PDQ‐NL) and Patient Reported Outcome Measurement (PROM). The primary outcome was reduction in curvature and the ability to have penetrating sex again. Secondary outcomes include pain scores during injections, changes in PDQ‐NL, PROM and complications of CCH treatment. Results Sixty‐three patients were included, mean age was 56.0 years (range 39–70) and mean reduction in curvature 20.6° (SD 10.2, range 5–49); 74.5% of the patients were able to have penetrating sex again following treatment, compared with 41.2% prior to treatment. According to the PROM questions, sexual improvement was seen in 66.7% of patients. The satisfaction rate was 6.8 (SD 1.8). All patients save two recommend treatment. Conclusions Intralesional treatment with CCH in men with PD leads to a mean curvature improvement of 20.6°. Following treatment, 74.5% of men were able to have sexual intercourse and 54.9% of the couples were satisfied with their sex life. No major complications occurred in the patients treated with CCH. CCH is not available in Europe anymore despite good results.

show abstract

“…64% of patients with moderate or severe hourglass deformity required subsequent corrective surgery. 32 The authors conclude there are low rates of CCH success on improving the volume loss in these patient cohorts with PD. Finally,…”

Section: Introductionmentioning

confidence: 88%

“…To that end, Ziegelmann et al conducted a retrospective study of 20 patients with unilateral indentation and 20 with hourglass deformity (defined as unilateral or bilateral subjective >10% girth discrepancy relative to the corpora proximal and distal to the area of maximum curvature). 32 From 40 patients, only 3/40 had significant improvement in indentation deformity after a mean number of 3.8 injections, with no improvement in penile curvature. 64% of patients with moderate or severe hourglass deformity required subsequent corrective surgery.…”

Section: Introductionmentioning

confidence: 94%

Expanded Utilization of Intralesional Therapies for Treatment of Peyronie’s Disease

Khooblall¹,

Bole²,

Lundy³

et al. 2023

RRU

Self Cite

View full text Add to dashboard Cite

Purpose In this narrative review we explore additional indications for which intralesional collagenase Clostridium histolyticum (CCH) injection therapy may be used, in addition to those utilized in the IMPRESS trials. The goal is to provide updated assessment of available intralesional therapies and justify whether to expand clinical indications based on advancements over the last decade. Results Patients receiving CCH in the acute phase of PD have shown significant improvement in penile curvature - which may be even more significant than reported due to progressive curvature over the longitudinal course of injection therapy. Across studies, patients with ventral plaques achieved the greatest curvature improvement (~30°) compared to PD patients with dorsal or lateral plaques. Patients with curvature > 90° have been minimally documented. However, the concept of patients with higher degree of curvature achieving more significant degrees of improvement prevails across studies. Studies including PD patients with volume loss deformities or indentation(s) focus on curvature improvement and do not gauge improvement in these girth loss or indentation features specifically. PD patients with calcification may benefit from CCH, however, critical analysis of included study designs and results compared to placebo do not lend for strong support of CCH in PD at this time. Conclusion Based on the most recent research, the use of CCH in the acute phase of PD and patients with ventral penile plaques may be effective and safe. The limited available research on the efficacy of CCH on calcified plaque(s) and curvature greater than 90° is promising, however, more research is needed to ensure safety and success in this patient cohort. Finally, the current literature continues to show the use of CCH is not effective in PD patients with volume loss, indentation, or hourglass deformity. When expanding the use of CCH to patients not originally included in the IMPRESS trials, providers must prioritize minimizing chances of potential injury to urethral tissue. Finally, further investigation is required to determine whether CCH has utility for curvature greater than 90° or calcified plaques, although the limited available literature is promising.

show abstract

The Influence of Indentation Deformity on Outcomes With Intralesional Collagenase Clostridium Histolyticum Monotherapy for Peyronie's Disease

Cited by 15 publications

References 30 publications

A systematic review of non-surgical management in Peyronieʼs disease

A systematic review of non-surgical management in Peyronieʼs disease

Improvement in the ability to have sex in patients with Peyronie's disease treated with Collagenase Clostridium histolyticum

Expanded Utilization of Intralesional Therapies for Treatment of Peyronie’s Disease

Contact Info

Product

Resources

About