Improved Peyronie's Disease Curvature Outcomes Using a Novel Collagenase Administration Protocol

Area of Science:

• Urology
• Andrology
• Regenerative Medicine

Background:

• Peyronie's disease (PD) is a connective tissue disorder characterized by fibrous scar tissue formation.
• Penile curvature and erectile dysfunction are common symptoms of PD, significantly impacting quality of life.
• Collagenase clostridium histolyticum (CCH) injections are a treatment option for PD, but optimal protocols are still being investigated.

Purpose of the Study:

• To evaluate the outcomes of a novel collagenase clostridium histolyticum (CCH) injection protocol for treating Peyronie's disease.
• To compare the efficacy and safety of the novel CCH protocol against a traditional protocol.

Main Methods:

• A prospective database of 509 men with Peyronie's disease undergoing CCH injections from 2015 onwards was analyzed.
• The study compared a "traditional" CCH protocol (n=280) with an evolved "novel" protocol (n=229) incorporating changes in injection technique, timing, modeling/traction, and wrapping.
• Outcomes were assessed using "most recent" and "completed eight or satisfied" definitions, focusing on penile curvature improvement, erectile function, and patient-reported outcomes.

Main Results:

• The novel CCH protocol demonstrated significantly greater improvements in penile curvature compared to the traditional protocol (e.g., 34° vs. 20° improvement in the "completed eight or satisfied" group).
• Higher percentages of men achieved substantial curvature improvement (≥20% and ≥50%) with the novel protocol (94% vs. 66% and 60% vs. 24%, respectively).
• The novel protocol showed no negative impact on the International Index of Erectile Function Erectile Function Domain score, improved subjective erectile function and sensation, and led to higher rates of surgery prevention and restored penetration, though with increased hematomas.

Conclusions:

• The novel CCH injection protocol leads to significant improvements in Peyronie's disease curvature.
• This protocol does not adversely affect erectile function or sensation.
• Due to its specialized nature, the novel protocol is recommended for experienced CCH injectors only.