Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.

JU INSIGHT Comparison of Collagenase Clostridium histolyticum to Surgery for the Management of Peyronie’s Disease

By: Benjamin Green, BA, Male Fertility and Peyronie’s Clinic, Orem, Utah; Ashley Flores, MBA, CURE PD, Orem, Utah; Jacob Warner, BS, Brigham Young University, Provo, Utah; Tobias Kohler, MD, Mayo Clinic, Rochester, Minnesota; Sevann Helo, MD, Mayo Clinic, Rochester, Minnesota; Landon Trost, MD, Male Fertility and Peyronie’s Clinic, Orem, Utah CURE PD, Orem, Utah, Brigham Young University, Provo, Utah Mayo Clinic, Rochester, Minnesota | Posted on: 27 Nov 2023

Green B, Flores A, Warner J, Kohler T, Helo S, Trost L. Comparison of collagenase Clostridium histolyticum to surgery for the management of Peyronie’s disease: a randomized trial. J Urol. 2023;210(5):791-802.

Study Need and Importance

Peyronie’s disease is a challenging condition, with many patients reticent to undergo invasive therapies. Since the release of collagenase Clostridium histolyticum (CCH), there has been ongoing debate as to its role in the overall treatment algorithm and comparison to surgery. To address this issue, we designed a randomized, controlled trial comparing CCH + RestoreX penile traction device + sildenafil (CCH group) to surgery + RestoreX + sildenafil (Surgery group), with 40 patients enrolled. The current study reports outcomes at 3 months posttreatment, with further results anticipated at 1 and 5 years.

What We Found

A total of 50% of CCH men reported being very satisfied vs 21% of Surgery men (primary outcome), with Surgery men reporting greater curve improvements (84% vs 54%). Men in the CCH arm experienced greater length gain (+1.0 cm vs −0.5 cm) and lower rates of side effects, including pain, lumps, and sensory changes/loss (Figure). Interestingly, both therapies had similar rates of subjective improvements in indentation/hourglass deformities and outcomes using standardized scales, with the exception of decreased orgasmic function in Surgery men.

image
Figure. Patients with persistent adverse events at 3 months posttreatment. CCH indicates collagenase Clostridium histolyticum.

Limitations

The current study is limited in size (n=38 with 3-month data) and not powered to demonstrate superiority of CCH or Surgery. Additionally, it represents a single-provider series and may not be reflective of other practices. Findings are also only representative of the 3-month time point and may change with longer follow-up.

Interpretation for Patient Care

Despite greater curve improvements with surgery, CCH results in at least equivalent (and possibly greater) satisfaction. Results may be driven by a lower side effect profile in CCH-treated men, including differences in length, pain, sensation, palpable abnormalities, and orgasmic function. Findings suggest that in addition to surgery, CCH + RestoreX + sildenafil may be considered a gold standard therapy for the management of Peyronie’s disease.

advertisement

advertisement