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“Can we try to avoid surgery first?”—Real-world experience with surgery for Peyronie’s disease in the post-intralesional collagenase setting

International Journal of Impotence Research volume 36, pages 171–172 (2024)Cite this article

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Peyronie’s disease (PD) is a fibrotic disorder of the penis characterized by the deposition of plaques in the tunica albuginea. These plaques give rise to pain, penile deformity, and sexual dysfunction, and can contribute to mental anguish. The only United States Food and Drug Administration (FDA) approved medication for the treatment of PD is intralesional collagenase Clostridium histolyticum, administered as a series of eight injections across four cycles of two injections each, coupled with manual mechanical modeling. The safety and efficacy of intralesional collagenase have been evaluated both prospectively and in a number of retrospective analyses [1]. It is clear that intralesional collagenase does not work for everyone. Prior to the introduction of intralesional therapy, surgical management was the mainstay of treatment, and surgery remains relevant in the modern era, particularly in patients who are not optimal candidates for intralesional therapy. These patients may include men with substantial plaque burden, plaque calcification, and ventral plaques. Reconstructive surgery for PD consists primarily of either tunica albuginea plication strategies (e.g., Nesbit, Yachia, and 16-dot techniques) and plaque excision or incision and grafting operations. For patients with concomitant erectile dysfunction (ED), penile prosthesis can be employed.

In our experience at an academic, high-volume center with >500 new consultations for PD annually, patients tend to express a preference for non-operative treatment options, even after undergoing extensive counseling and shared decision-making about the chances of success relative to degree of severity. In light of this, for several years, we have been offering patients multiple full courses of intralesional collagenase (i.e., >8 injections), for which outcomes have been published recently [2]. Previously, the Investigation for Maximal Peyronie’s Reduction Efficacy and Safety Studies (IMPRESS) phase 3 clinical trials on the efficacy of intralesional collagenase demonstrated a mean curvature improvement of 34% after a full course of 8 injections, defining clinical improvement as a 20% reduction in penile curvature [1]. In our series, 229 patients completed one full course of 8 injections, 80 patients completed two full courses (16 injections), and 18 patients completed three full courses (24 injections). Only 42.8% of patients who completed one full course achieved a clinical improvement in their curvature; among patients who went on to complete three rounds, 12.5% received clinical improvement with a mean percent reduction of 8.1% in penile curvature [2].

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References

  1. Zhang F, Xiong Y, Wang W, Wu C, Qin F, Yuan J. The efficacy and safety of intralesional injection of collagenase Clostridium histolyticum for Peyronie’s disease: a meta-analysis of published prospective studies. Front Pharmacol. 2022;13:973394.

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Authors and Affiliations

  1. Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Reza Kianian, Keith V. Regets, Jesse N. Mills & Sriram V. Eleswarapu

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  1. Reza Kianian
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  2. Keith V. Regets
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  3. Jesse N. Mills
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  4. Sriram V. Eleswarapu
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Contributions

Conceptualization: RK, JNM, and SVE; Data curation: RK and KVR; Formal analysis: RK, JNM, and SVE; Investigation: RK, KVR, JNM, and SVE; Project administration: RK, KVR, JNM, and SVE; Supervision: JNM and SVE; Visualization: RK and SVE; Writing – original draft: RK, KVR, JNM, and SVE. Writing – review & editing: RK, KVR, JNM, and SVE.

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Correspondence to Sriram V. Eleswarapu.

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Competing interests

JNM serves as a consultant to Boston Scientific Corporation, Endo Pharmaceuticals, and Halozyme Therapeutics and receives compensation. KVR serves as a speaker for Boston Scientific Corporation and Halozyme Therapeutics and receives compensation. RK and SVE declare no potential conflicts of interest.

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Kianian, R., Regets, K.V., Mills, J.N. et al. “Can we try to avoid surgery first?”—Real-world experience with surgery for Peyronie’s disease in the post-intralesional collagenase setting. Int J Impot Res 36, 171–172 (2024). https://doi.org/10.1038/s41443-023-00713-5

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