Outcomes of Surgery in Peyronie’s Disease Following Intralesional Collagenase Clostridium Histolyticum Injections

Bazzi, Mahdi; Jamil, Marcus; Dabaja, Ali

doi:10.1007/s11934-019-0910-8

Cited by 5 publications

(6 citation statements)

References 49 publications

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“…However, this study reports findings from the largest series ever published of surgery after intraplaque CCH injections persistence of penile curvature 30 . www.nature.com/scientificreports/…”

Section: Discussionmentioning

confidence: 88%

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

Cocci

Ralph²,

Djinovic³

et al. 2021

Sci Rep

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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.

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Section: Discussionmentioning

confidence: 88%

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

Cocci

Ralph²,

Djinovic³

et al. 2021

Sci Rep

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“…Thus with limited evidence available, it appears that previous intralesional CCH injection should not necessarily preclude patients from undergoing subsequent surgical correction of residual curvature; however, it may slightly increase intraoperative difficulty if surgery is offered within the first 3 months from the last CCH injection. 158 In cases of ReC following plication or grafting procedures, no clear recommendations can be provided due to a paucity of available data regarding the decision to perform revision surgery. It is generally agreed that revision surgery should be postponed for at least 6 months to allow for normal healing to occur and to assess whether a new deformity or de-novo ED develops.…”

Section: Evidencementioning

confidence: 99%

ESSM Position Statement on Surgical Treatment of Peyronie's Disease

et al. 2021

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Introduction Patients with Peyronie's disease may experience significat distress. The choice of treatment depends on a variety of factors, including the stage of the disease, the presence of pain, severity and direction of the curvature, penile length and the quality of erectile function. Aim To review the evidence associated with surgical treatment of Peyronie‘s Disease and provide clinical recommendations on behalf of the European Society for Sexual Medicine. 131 peer-reviewed studies and systematic reviews, which were published from 2009 to 2019 in the English language, were included. Methods MEDLINE, Google Scholar and EMBASE were searched for randomized clinical trials, meta-analyses, open-label prospective and retrospective studies. Main Outcome Measure The panel provided statements on clinically relevant questions including patient involvement in the decision process, indications for surgery, choice of the approach, and the management of patient expectations. A comparison of the different grafts used in patients who have undergone plaque incision/excision and grafting in order to identify an ideal graft, has been carried out. The prevalence of postoperative complications has been summarized. Levels of evidence were provided according to the Oxford 2011 criteria and Oxford Centre for Evidence-Based Medicine recommendations. Results In order to allow shared decision making, a patient preoperative counselling regarding the pros and cons of each intervention is recommended. In particular, adverse effects of surgical treatments should be discussed to set realistic understanding and expectations of surgical outcomes and ultimately improve postoperative satisfaction rates. Surgical treatment should be only offered in the chronic phase of the condition, when the deformity and/or degree of erectile dysfunction, prevent patients from engaging in satisfying sexual interaction, or if the deformity is the cause of severe bother. Conclusions Current European Society for Sexual Medicine recommendations cover several aspects of Peyronie's disease treatment. These recommendations aim both to ensure patients and partners have accurate and realistic expectations of their treatment options, as well as to formulate algorithms to guide clinician management pathways. Osmonov D, Ragheb A, Ward S et al, ESSM Position Statement on Surgical Treatment of Peyronie's Disease. Sex Med 2022;10:100459.

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“…Molecules such as corticosteroids, verapamil, interferon, and collagenase clostridium histolyticum are commonly used in intralesional therapy 5 . Amongst these, collagenase clostridium histolyticum stands out as the most effective agent, and many studies have proven its effectiveness 1,7‐9 . However, in some countries, this drug is difficult to obtain, and the cost of treatment protocols with this drug can be excessive.…”

Section: Introductionmentioning

confidence: 99%

“…5 Amongst these, collagenase clostridium histolyticum stands out as the most effective agent, and many studies have proven its effectiveness. 1,[7][8][9] However, in some countries, this drug is difficult to obtain, and the cost of treatment protocols with this drug can be excessive. In addition, collagenase was withdrawn from the European market for commercial reasons.…”

mentioning

confidence: 99%

Intralesional low‐dose methylprednisolone for the treatment of active phase Peyronie’s disease: A single‐centre, preliminary prospective non‐randomised study

Üre

Özen

2020

Int J Clin Pract

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Aim There are a few types of drugs that can be used in the active phase of Peyronie's disease. Methylprednisolone is a corticosteroid with a strong anti‐inflammatory effect. In this study, we aimed to evaluate the effect of intralesional low‐dose methylprednisolone treatment on patients in the active phase of Peyronie's disease. Patients and Methods Forty‐eight patients suffering from Peyronie's disease active phase symptoms were included in the study. Methylprednisolone was administered intralesionally for 8 weeks, once per week, at a dose of 40 mg. The injection was applied to the plaques, which causes maximum curvature. Patients were evaluated before and after treatment for plaque size, angle of curvature, and erectile dysfunction according to the International Index of Erectile Function‐5 and Peyronie's Disease Questionnaire. Results The mean age of the patients was 61.1 (43‐78) years. The mean duration of the symptoms was 3.4 (0‐9) months. The average plaque size before treatment was 13.6 mm (7.1‐16.8) and after treatment, this value decreased to 10.8 mm (4.3‐14.6) (P: .025). The average scores of Peyronie's Disease Questionnaire elements; symptom severity, penile pain, and bother/discomfort were 12.3, 19.1, and 6.2, respectively, before the treatment. These scores were decreased to 8.9, 9.6, and 4.4, respectively, after treatment. All subgroups of Peyronie's Disease Questionnaire scores were significantly improved after treatment (P: .001, P < .001, P: .045, respectively). No adverse events were observed during or after treatment. Conclusion In order to recover the symptoms and signs, new and easily accessible drugs are required for use in the acute period of Peyronie's disease. In this context, treatment with intralesional low‐dose methylprednisolone in acute phase Peyronie's Disease is a promising and safe treatment option.

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Outcomes of Surgery in Peyronie’s Disease Following Intralesional Collagenase Clostridium Histolyticum Injections

Cited by 5 publications

References 49 publications

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

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

ESSM Position Statement on Surgical Treatment of Peyronie's Disease

Intralesional low‐dose methylprednisolone for the treatment of active phase Peyronie’s disease: A single‐centre, preliminary prospective non‐randomised study

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