Optimizing collagenase Clostridium histolyticum therapy for Peyronie’s disease using a novel approach with percutaneous needle tunnelling

Abstract

Objectives To compare the efficacy and safety of a combined treatment of percutaneous needle tunnelling (PNT) and a modified collagenase Clostridium histolyticum (CCH) protocol (PNT/CCH) vs the modified protocol alone (CCH) in the treatment of Peyronie's disease (PD). Patients and Methods A prospective registry of patients treated with a modified CCH protocol was maintained between June 2014 and February 2018. The last 50 patients received PNT as an adjuvant therapy (PNT/CCH), and their data were compared with those of the other 94 patients treated previously (CCH). PNT involves the creation of multiple holes made percutaneously in the plaque before each injection. The modified protocol consisted of two collagenase injections, at 1‐week intervals, followed by penile modelling. Patients used penile traction therapy, tadalafil and pentoxifylline for the next 2 months and were followed up for 6 months. The main outcome was improvement of curvature. Secondary outcomes were improvements in erectile function, PD symptoms, stretched penile length and satisfaction. Results Improvement in curvature was greater in patients in the PNT/CCH group than in the CCH group (mean ± sd 19.2 ± 6.1° vs 12.7 ± 5.0°; P < 0.001 [36.2 ± 12.5% vs 28.1 ± 14.5%; P = 0.001]). Compared with baseline, both interventions were associated with significant improvement in secondary outcomes. The main complications were ecchymosis, bruising and penile pain, with no significant differences between groups. Conclusions Treatment of PD with CCH using our modified protocol in combination with PNT is safe and more effective than the modified protocol alone, with the potential for improved cost‐effectiveness.

The Use of Penile Traction Devices for Peyronie's Disease: Position Statements from the European Society for Sexual Medicine

“…Finally, more recently, the study by Fernandez-Pascual et al 27 was designed to evaluate the differences in a new percutaneous technique along with CCH and PTT, so it is not possible to draw any conclusions about the interaction of PTT itself in the results observed.…”

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

“…Percutaneous needle tunnelling (PNT) is a procedure described by Pascual et al (Fernández‐Pascual et al., 2019) that consists of creating multiple tunnels or holes along the penile plaque before the administration of CCH. PNT mimics percutaneous needle fasciotomy, used in the treatment of Dupuytren's disease (DD; Skov, Bisgaard, Søndergaard, & Lange, 2017).…”

“…In the IMPRESS trials, collagenase was directly injected into the primary plaque at the point of maximal penile curvature deformity with a standardized injection technique, with no mention of penile nerve block before the injection (Gelbard et al., 2013). However, in the following years, other authors in their works using CCH injections do specify the use of penile block prior to the treatment (Abdel Raheem, Capece, et al, 2017; Capece et al., 2018; Fernández‐Pascual et al., 2019).…”

Мodern Non-Invasive Methods for Treating Peyronie's Disease

“…In Europe, this therapy is not approved, and on December 5, 2019, the European Commission withdrew the marketing authorization for Xiapex (CCH) in the European Union (EU), but it is recommended as a therapy by the European Urological Association (EAU) [14]. Since then, more than 100 studies have been published showing intralesional CCH therapy with improvement in penile deviation (and erectile function), also describing a significant reduction in plaque volume [56][57][58][59], (Table 2). The price on an annual basis is stated to be around $18,000.…”

“…Placebocontrolled studies have shown that saline injection and injection volume can improve penile deviation and plaque size [12,14,142]. Data suggest, for example, that in the intralesional application of CCH, the injection technique is important [58]. Studies are available that speak to the importance of the combination of different approaches [58].…”