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To compare in a prospective, non-randomized fashion the outcomes of Collagenase Clostridium Histolyticum (CCH) and surgical interventions (tunical plication [TP] and partial plaque excision and grafting [PEG]) in patients with PD. Intralesional injection of CCH is the only Food and Drug Administration-approved non-surgical intervention for Peyronie's disease (PD).

Between 6/2015 and 1/2017, 57 patients with PD and dorsal, dorsolateral and/or lateral penile curvatures 30-90 degrees were included in this study. Patients with ventral curvature, hourglass deformity, and previous surgery for PD were excluded. All patients completed questionnaires and underwent penile measurements and penile vascular studies prior to and after completion of treatment and were followed for at least six months.

CCH was performed in 18 patients, TP in 14, and PEG in 25. The median follow-up for the whole cohort was 12 months (6-28). Mean changes in curvature after treatment were 23.3° (34.4%) for CCH, 72.0° (92.2%) for TP and 71.8 ° (94.9%) for PEG, p<0.001. Mean changes in International Index of Erectile Function-5 scores were +5.7 for CCH, +4.9 for TP and +2.2 for PEG, p=0.395. Mean penile length changes were -0.2cm for CCH, -1.0cm for TP and +0.9cm for PEG, p<0.001. Three patients in the CCH group had bothersome residual curvature and underwent uneventful TP.

Surgical options are associated with superior curvature correction. CCH is an effective and safe option for motivated patients who prefer to avoid surgery. PEG is associated with a small stretched penile length gain.

Urology. 2018 Jul 27 [Epub ahead of print]

Faysal A Yafi, Linley Diao, Kenneth J DeLay, Ling DeYoung, Riad Talib, Laith Alzweri, Gerald Brock, Wayne J G Hellstrom, Georgios Hatzichristodoulou

University of California, Irvine, CA, USA., Tulane University, New Orleans, LA, USA., Advanced Urology Institute, Tallahassee, FL, USA., University of Western Ontario, London, ON, Canada., Tulane University, New Orleans, LA, USA. Electronic address: ., Julius-Maximilians-University of Würzburg, Würzburg, Germany.

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