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How Atypical Penile Curvature Influence Clinical Outcomes in Patients with Peyronie's Disease Receiving Collagenase Clostridium Histolyticum Therapy?

Published on Jan 1, 2019in The World Journal of Men's Health2.269
· DOI :10.5534/wjmh.190026
Andrea Cocci9
Estimated H-index: 9
(UniFI: University of Florence),
Fabrizio Di Maida4
Estimated H-index: 4
(UniFI: University of Florence)
+ 9 AuthorsNicola Mondaini30
Estimated H-index: 30
Abstract
PURPOSE: The aim of this study was to evaluate the efficacy of collagenase Clostridium histolyticum (CCH) in patients with Peyronie's disease (PD) suffering from atypical deformities. MATERIALS AND METHODS: We retrospectively collected data of patients with atypical penile curvature (PC) secondary to PD. All patients underwent a modified treatment protocol, consisting of 3 intralesional injections of 0.9 mg of CCH performed at 4-week intervals at the point of maximum PC. Patients were instructed to follow a strict routine, involving daily modeling of erect penis and stretching at the urinary toilette time, two minutes each. Success was defined as a decrease in PC of ≥20° from baseline. RESULTS: Sixty-five patients were included in the analysis. Median age was 59.0 years (interquartile range [IQR], 53.0 to 63.0 years), median curvature 40.0° (IQR, 30.0° to 45.0°) median duration of the disease 12.0 years (IQR, 6.5 to 24.0 years). Fifty-three patients (81.54%) had ventral PC, 7 (10.77%) hourglass PC, and 5 (7.69%) shortening PC. Median changes of PC were -20.0 (IQR, -20.0 to -10.0; p<0.01) in ventral PC, -20.0 (IQR, -20.0 to 0; p<0.01) in hourglass and -15.0 (IQR, -15.0 to -15.0; p<0.01) in shortening PC. At Kruscal-Wallis test, significant differences between groups were not found. The rate of PC success was 56.60% (30/53) in ventral PC, 57.14% (4/7) in hourglass and 20.00% (1/5) in shortening PC (p=0.29). Treatment success was not influenced by characteristics of curvature (odds ratio=0.66; p=0.20). CONCLUSIONS: CCH intralesional injections could represent an effective therapeutic option for the conservative management of patients with atypical PC.
  • References (27)
  • Citations (1)
References27
Newest
#1R. Avant (Mayo Clinic)H-Index: 3
#2Matthew Ziegelmann (Mayo Clinic)H-Index: 11
Last. Landon Trost (Mayo Clinic)H-Index: 23
view all 6 authors...
Abstract Introduction Peyronie's disease (PD) has historically been managed by at least 1 treatment, including oral supplements or medications, intralesional injections, or surgery. Adjunctive mechanical therapies also have been described, including penile traction therapy (PTT) and vacuum erection devices (VEDs), although relatively limited data are available on their use with PD. Aim To review and summarize the published literature on the role and efficacy of PTT and VED in men with PD. Method...
4 CitationsSource
#1Andrea Cocci (UniFI: University of Florence)H-Index: 9
#2Gianmartin Cito (UniFI: University of Florence)H-Index: 6
Last. Giorgio Ivan Russo (University of Catania)H-Index: 21
view all 22 authors...
Abstract Introduction The effectiveness of phosphodiesterase type 5 (PDE5) inhibitors over the conservative management of Peyronie’s disease (PD) has been widely questioned. Aim To determine the role of sildenafil 25 mg film formulation twice a day (S25 b.i.d.) in the improvement of curvature after treatment of collagenase of Clostridium hystoliticum (CCH) in penile curvature owing to PD. Methods From April 2017 to April 2018, 161 consecutive patients were treated with S25 b.i.d. + CCH or CCH al...
5 CitationsSource
#1Andrea Cocci (UniFI: University of Florence)H-Index: 9
#2Giorgio Ivan Russo (University of Catania)H-Index: 21
Last. Nicola MondainiH-Index: 30
view all 20 authors...
OBJECTIVE: To build a nomogram able to predict treatment success after collagenase Clostridium histolyticum (CCH) for Peyronie's disease (PD). MATERIALS AND METHODS: Between November 2016 and November 2017, we enrolled 135 patients with PD into a multicentre single-arm prospective study. All patients enrolled received CCH treatment. Success of therapy was defined as a decrease in penile curvature (PC) of ≥20° from baseline. Treatment satisfaction was assessed using a scale from 1 to 10, and high...
9 CitationsSource
#1Marco CapeceH-Index: 8
#2Andrea CocciH-Index: 9
Last. Nicola MondainiH-Index: 30
view all 21 authors...
: Peyronie's disease (PD) is a common condition which results in penile curvature making sexual intercourse difficult or impossible. Collagenase clostridium histolyticum (CCH) is the first licensed drug for the treatment of PD and is indicated in patients with palpable plaque and curvature deformity of at least 30° of curvature. However, only few monocentric studies are available in the current literature and this is the first national multicentric study focusing on this new treatment. In five I...
11 CitationsSource
#1Andrea Cocci (UniFI: University of Florence)H-Index: 9
#2Giorgio Ivan Russo (University of Catania)H-Index: 21
Last. Nicola MondainiH-Index: 30
view all 20 authors...
Abstract Background Collagenase Clostridium histolyticum (CCH; Xiapex) injections represent the only licensed medical treatment for Peyronie's disease (PD). Aim To evaluate the efficacy and safety of CCH injections in men with stable PD, using a modified treatment protocol and to assess partners' bother improvement in a large cohort of White-European sexually active heterosexual men treated in a single tertiary-referral center. Methods All the 135 patients enrolled underwent a thorough assessmen...
8 CitationsSource
#1Amr Abdel Raheem (Cairo University)H-Index: 12
#2M. Capece (UCLH: University College Hospital)H-Index: 2
Last. David J. Ralph (UCLH: University College Hospital)H-Index: 46
view all 10 authors...
Objectives To evaluate the efficacy and safety of collagenase clostridium histolyticum (CCH) (Xiapex®, Xiaflex®) in the treatment of Peyronie's disease (PD) using a new modified treatment protocol which aims at reducing the number of injections needed and reducing patient visits, thus reducing the cost and duration of treatment. Patients and Methods A prospective study of 53 patients with PD who had treatment with CCH at a single center using a new modified protocol. The angle of curvature asses...
29 CitationsSource
#1David J. Ralph (UCL: University College London)H-Index: 46
#2Amr Abdel Raheem (UCL: University College London)H-Index: 12
Last. Genzhou Liu (Endo International plc)H-Index: 1
view all 3 authors...
Abstract Background Collagenase Clostridium histolyticum (CCH) is indicated for the treatment of penile curvature in adult men with Peyronie's disease (PD) with palpable plaque and curvature deformity of at least 30° at the start of therapy. Aim To evaluate the efficacy and safety of CCH plus vacuum-pump therapy with and without penile modeling for the management of PD. Methods Adult men with PD and penile curvature of at least 30° were randomly assigned to receive CCH 0.58 mg plus vacuum therap...
9 CitationsSource
#1Matthew Ziegelmann (Mayo Clinic)H-Index: 11
#2Boyd R. Viers (Mayo Clinic)H-Index: 15
Last. Landon Trost (Mayo Clinic)H-Index: 23
view all 6 authors...
Objective To evaluate the outcomes in men undergoing collagenase Clostridium histolyticum (CCH) with concurrent penile traction therapy (PTT) for the treatment of Peyronie disease (PD). Materials and Methods We identified patients treated with CCH between March 2014 and July 2016. Patients were recommended to perform modeling and PTT between injection series. A final curve assessment was performed after patients completed CCH. A prospective database was maintained, including patient-reported fre...
16 CitationsSource
#1Faysal A. Yafi (Tulane University)H-Index: 19
#2Georgios Hatzichristodoulou (TUM: Technische Universität München)H-Index: 14
Last. Wayne J.G. Hellstrom (Tulane University)H-Index: 63
view all 4 authors...
Abstract Introduction Peyronie's disease (PD) is a wound-healing disorder of the tunica albuginea often associated with penile deformity. Less commonly, patients with PD might display atypical presentations such as ventral curvature, hourglass deformity, significantly shortened penis, and/or multiplanar curvature. Aim To review the available literature on the prevalence of and management options for atypical PD. Methods A literature review was performed through PubMed from 1982 through 2016 rega...
13 CitationsSource
#1Faysal A. Yafi (Tulane University)H-Index: 19
#2Georgios Hatzichristodoulou (TUM: Technische Universität München)H-Index: 14
Last. Wayne J.G. Hellstrom (Tulane University)H-Index: 63
view all 6 authors...
Abstract Introduction Approximately 10% of Peyronie's disease (PD) patients present with ventral curvatures and, as such, there is a paucity of data describing the optimal approach for treatment. Aim This study aims to compare the outcomes of surgery (tunical plication [TP]) and intralesional injection (ILI) therapy (interferon‐α2b) in men with ventral PD. Materials and Methods Retrospective data were collected from two centers: Tulane University (ILI) and Technical University of Munich (TP). Co...
10 CitationsSource
Cited By1
Newest
#1Andrea Cocci (UniFI: University of Florence)H-Index: 9
#2Fabrizio Di Maida (UniFI: University of Florence)H-Index: 4
Last. Marco Falcone (UNITO: University of Turin)H-Index: 12
view all 16 authors...
BACKGROUND AND OBJECTIVE: Plaque formation ordinarily takes place in the acute phase of Peyronie's disease. There is no unanimous consent regarding the management of the acute phase of Peyronie's disease. The objective of this study was to evaluate the advantages of using a single intralesional injection of collagenase Clostridium histolyticum in patients with the active phase of Peyronie's disease and to assess its effect on disease progression by reducing penile curvature and ameliorating pain...
Source
#1Caleb Natale (Tulane University)H-Index: 1
#2David M. McLellan (Tulane University)
Last. Wayne J.G. Hellstrom (Tulane University)H-Index: 63
view all 4 authors...
INTRODUCTION: Collagenase Clostridium histolyticum (CCH) is an injectable agent used to treat Peyronie's disease (PD) by enzymatically degrading the interstitial collagen in plaques. CCH has been administered via multiple treatment protocols, in combination therapies, to patients with varying curvatures and in both the acute and stable phases of this condition. OBJECTIVES: To review the current literature and provide an update on CCH as an injectable therapy for PD, as a singular therapy or in c...
Source
#1Matthew Ziegelmann (Mayo Clinic)H-Index: 11
#2Daniel L. Heslop (Mayo Clinic)
Last. Tobias S. Köhler (Mayo Clinic)H-Index: 15
view all 7 authors...
Objective To identify patient-specific factors associated with patient-reported improvements in functional outcomes after intralesional Collagenase Clostridium histolyticum for Peyronie's Disease (PD). Methods We retrospectively explored our prospectively-maintained CCH registry. We sought to identify patient-specific factors that prevented the need for surgical straightening and/or improved ability to engage in penetrative intercourse. Results 86 patients underwent CCH monotherapy and had objec...
Source
#1Andrea Cocci (UniFI: University of Florence)H-Index: 9
#2Fabrizio Di Maida (UniFI: University of Florence)H-Index: 4
Last. Giovanni Cacciamani (University of Verona)H-Index: 10
view all 13 authors...
PURPOSE: To compare the efficacy and safety of intralesional hyaluronic acid (HA) as compared with verapamil injection in patients with Peyronie's disease (PD). MATERIALS AND METHODS: Between January 2015 and December 2018, men in PD acute phase were prospectively recruited. This open-label, prospective study included 2 different protocols. Group A: 8-week cycle of weekly intraplaque injections with HA; Group B: 8-week cycle of weekly intraplaque injections with verapamil. Penile curvature, plaq...
1 CitationsSource
#1Patrick Teloken (Royal Brisbane and Women's Hospital)H-Index: 12
#2Darren J. KatzH-Index: 14
Peyronie’s disease is a condition that causes abnormal healing of the tunica albuginea, causing penile curvature. It is difficult to treat and its management is continuing to evolve. Proposed non-surgical treatments have included oral, topical, intralesional, extracorporeal shockwave, and traction therapy. The study of Peyronie’s disease is made difficult by heterogeneity in the timing of presentation, severity and characteristics of deformity, and associated complaints. Moreover, meta-analyses ...
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