Collagenase <em>Clostridium histolyticum</em> in the treatment of Peyronie&rsquo;s disease: patient selection and perspectives

Abstract

The safety and efficacy of the use of collagenase Clostridium histolyticum (CCH) for the treatment of Peyronie’s disease has been confirmed over the past several years. However, identification of the ideal patient population for use of this treatment is not well established. Multiple studies have attempted to delineate various patient-specific factors that may predict response to treatment with CCH, with the intent of enhancing patient selection. To date, these include baseline curvature severity, duration of disease, disease phase at presentation, plaque calcification, baseline erectile function, plaque size, age, comorbid diabetes, previous penile trauma, responsiveness to first treatment cycle, baseline penile shortening or pain, prior treatment with intralesional injection, compliance with plaque modeling, and atypical curvature. In addition, other studies have sought to explore various aspects of treatment with CCH that may affect patient perspective of treatment. They have focused on patient-reported outcomes, female partner considerations, cost of treatment, and potential confounders of patient satisfaction. This review provides a summary and analysis of currently available literature on topics of patient selection and perspectives in regard to treatment of Peyronie’s disease with CCH.

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

“…Multivariable linear regression was used to assess the independent association between phase of PD and percent change in curvature. Confounding variables and potential effect modifiers were selected a priori and based on previous literature (4,7,31,(33)(34)(35)(36). These included patient characteristics such as age; race/ethnicity; history of diabetes; smoking status; history of genitourinary surgery or Dupuytren's contracture; and disease characteristics such as concomitant ED, initial degree of curvature, primary curvature direction, size of palpable plaque, presence of two palpable plaques, and history of collagenase injections with an outside urologist prior to initial consultation within our system.…”

Penile surgery for patients with Peyronie’s disease initially treated with collagenase clostridium histolyticum or surgery: a claims database analysis

“…The selection of CCH or surgery as the initial treatment for PD depends on multiple factors, including a number of disease-related and patient-specific factors and patient and clinician preferences [ 19 ]. There is general consensus that penile surgery is indicated only after PD has stabilized and entered the chronic phase, in order to reduce the likelihood of deformity recurrence [ 20 , 21 ].…”