Treatment-related Outcomes for Patients With Atypical Peyronie's Disease Using Xiaflex Injections

El‐Khatib, Farouk M.; Osman, Mohamad M.; Kopelevich, Alexei; Towe, Maxwell; Yafi, Faysal A.

doi:10.1016/j.urology.2020.05.076

Cited by 8 publications

(8 citation statements)

References 17 publications

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“…The overall mean improvement in curvature was 19° ( p = 0.0079). 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 .…”

Section: Discussionmentioning

confidence: 94%

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

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 94%

“…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: Complicationsmentioning

confidence: 91%

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

et al. 2022

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“…Despite 10% of patients with PD presenting with ventral plaques, this patient population has commonly been excluded from studies due to concerns of urethral injury with intralesional therapies; thus, current guidelines do not support the use of intralesional therapies for these patients. 24 Unlike the other non-CCH injection therapies that have shown positive results for ventral plaques, the use of CCH has been hypothesized to cause structural changes of the urethra and surrounding tissues due to its impact on collagen type I and III. 25 However, a preliminary study using rat models investigated the use of CCH to treat urethral fibrosis, a fibrotic proliferative condition similar to PD, in collagen type and found injections to reduce urethral fibrosis and expression of collagen type I and III without any adverse effect to the urethral tissues.…”

Section: Introductionmentioning

confidence: 99%

“…They found a statistically significant −20.3 ± 8.1° (p= 0.0001) improvement of curvature in this population. 24 They also assessed treatment outcomes in 7 patients with multiplanar penile deformities with a baseline curvature of 36.7° and found a statistically significant 15.8 ± 8.0° (p=0.0001) improvement in this population. 24 Caution must be used in interpretation of these results as the degree of improvement in some cases was self- assessed by patients, which has been proven to significantly differ from in-office measurements.…”

Section: Introductionmentioning

confidence: 99%

“… 24 They also assessed treatment outcomes in 7 patients with multiplanar penile deformities with a baseline curvature of 36.7° and found a statistically significant 15.8 ± 8.0° (p=0.0001) improvement in this population. 24 Caution must be used in interpretation of these results as the degree of improvement in some cases was self- assessed by patients, which has been proven to significantly differ from in-office measurements. 31 Several other studies of unilateral indentation have been conducted, however, they lack subgroup analysis on the effects of intralesional CCH therapy in these cohorts.…”

Section: Introductionmentioning

confidence: 99%

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

Khooblall¹,

Bole²,

Lundy³

et al. 2023

RRU

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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.

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A Consistent Lack of Consistency in Defining the Acute and Chronic Phases of Peyronie's Disease: A Review of the Contemporary Literature

Piraino

Chaudhray

Ames

et al. 2022

Sexual Medicine Reviews

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Introduction Treatment recommendations for Peyronie's Disease (PD) differ based on whether a patient is in the acute/active versus chronic/stable phase of the disease, yet there are no agreed upon criteria for defining these clinical entities. Objectives To review the criteria used to define acute and chronic phase PD in modern PD intervention studies Methods We performed a search engine review to identify indexed publications for PD intervention studies and review articles / meta-analyses from the year 2011-2020. Outcomes results were catalogued and summarized across articles. As a result of the substantial heterogeneity of outcome measures and follow-up intervals, meta-analytic techniques were not applied to the data analysis. Results We identified a total of 104 studies that met inclusion criteria and had available information for review (n = 79 primary intervention studies; n = 25 review articles/meta-analyses/guidelines). Among the queried studies, we were unable to identify a consensus with respect to the criteria used to define acute and chronic phases of PD. 33% of primary intervention studies did not specifically define their criteria for acute and chronic phase PD, despite referencing these populations as part of the inclusion criteria in many instances. Studies used heterogenous criteria including total symptom duration, duration of “stable” symptoms, and presence/absence of pain. Conclusion Due to varying definitions across the literature, we were unable to create a standardized definition of acute and chronic phase Peyronie's in terms of time. Our findings emphasize the need for greater consensus in defining the treatment cohorts with future studies that assess treatment for men with PD.

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Treatment-related Outcomes for Patients With Atypical Peyronie's Disease Using Xiaflex Injections

Cited by 8 publications

References 17 publications

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

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

A Consistent Lack of Consistency in Defining the Acute and Chronic Phases of Peyronie's Disease: A Review of the Contemporary Literature

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