The Influence of Indentation Deformity on Outcomes with Intralesional Collagenase Clostridium histolyticum Monotherapy for Peyronie's Disease.

To identify patient-specific factors associated with patient-reported improvements in functional outcomes after intralesional Collagenase Clostridium histolyticum for Peyronie's Disease (PD).

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.

86 patients underwent CCH monotherapy and had objective follow-up data available. Mean PD symptom duration was 25 months (SD 44) and baseline curvature was 65o (SD 24). Prominent indentation/hourglass deformities (defined as girth discrepancy > 10%) were present in 40 patients (47%). Mean objective curve improvement was 19o (SD 20), and 60% achieved improvement ≥ 15o. Greater baseline curvature was associated with greater absolute improvements in curvature, although there was no association between baseline curvature and relative (%) improvement. 3/40 patients (8%) with indentation achieved girth improvement. Patients with baseline indentation/hourglass were less likely to report that CCH prevented the need for surgery (35% vs 64%, p=0.018). Patients with curve improvement < 15o were also less likely to report that CCH prevented the need for surgery (25% vs 63%, p=0.0086) or improved penetration (54% vs 89%, p=0.018).There were no differences in outcomes based on age, BMI, symptom duration, and presence of biplanar curvature.

Baseline indentation/hourglass deformity and curve improvement < 15o are associated with less favorable functional improvements such as preventing the need for surgery and improving penetration.

Urology. 2020 Feb 10 [Epub ahead of print]

Matthew J Ziegelmann, Daniel Heslop, Matthew Houlihan, Petar Bajic, Sevann Helo, Landon Trost, Tobias Kohler

Department of Urology, Mayo Clinic, Rochester, MN. Electronic address: ., Department of Urology, Mayo Clinic, Rochester, MN., Division of Urology, Rush University Medical Center, Chicago, IL.