Surgical outcomes after collagenase Clostridium histolyticum failure in patients with Peyronie's disease in a multicenter clinical study.

In the present study we aimed to investigate the surgical outcomes of patients with persistent penile curvature (PC) after Collagenase Clostridium histolyticum (CCH) intraplaque injections. Data from 90 patients with persistent PC after CCH in a multicentre study from 6 andrological centres were retrospectively reviewed. Three standardized surgical techniques were performed. Group 1: plaque incision grafting (PIG) with penile prosthesis implant (PPI); Group 2: PIG without PPI; Group 3: Nesbit technique. Hospital stay, operative time, postoperative complications and PC persistency/recurrence (> 20°) were evaluated. Overall satisfaction and functional outcomes were assessed through International Index of Erectile Function-Erectile Function (IIEF-EF), Peyronie's Disease Questionnaire (PDQ), Female Sexual Function Index (FSFI) administered pre and 3 months postoperatively. Of all, 25 (27.8%) patients received grafting procedure + PPI (Group 1), 18 (20.0%) patients belonged to Group 2, and 47 (52.2%) to Group 3. Bovine pericardium graft and collagen fleece have been used in in 22 (51.2%) and 21 (48.8%) patients, respectively. Median penile length after surgery was 13.0 cm (IQR 12.0-15.0). After surgery, Group 1 showed higher increase in penile length after surgery and better improvements in terms of PDQ-PS. In contrast, both IIEF-EF and FSFI scores did not differ among groups. Overall, 86 (95.6%) did not report any complication. 4 (4.4%) patients had PC recurrence; of those, 2 (8.0%), 1 (5.6%) and 1 (2.1%) cases were observed in Group 1, Group 2 and Group 3, respectively. In case of persistent PC after CCH, surgical correction by grafting with or without concomitant PPI or Nesbit technique emerged as a technically feasible, effective and safe procedure, with no significant postoperative complications.

Scientific reports. 2021 Jan 08*** epublish ***

Andrea Cocci, David Ralph, Rados Djinovic, Georgios Hatzichristodoulou, Girolamo Morelli, Andrea Salonia, Paolo Capogrosso, Andrea Romano, Gianmartin Cito, Fabrizio Di Maida, Esaú Fernández-Pascual, Javier Romero-Otero, Paulo Egydio, Marco Falcone, Mirko Preto, Giovanni Chiriacò, Jack Beck, Maarten Albersen, Suks Minhas, Giovanni Cacciamani, Juan Ignacio Martinez Salamanca, Nicola Mondani, Andrea Minervini, Giorgio Ivan Russo

Department of Urology, Careggi Hospital, University of Florence, Florence, Italy., St. Peter's Andrology Centre and UCLH, London, UK., Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, BelMedic General Hospital, Belgrade, Serbia., Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany., Department of Urology, Cisanello Hospital, University of Pisa, Pisa, Italy., Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy., Lyx Institute of Urology, Universidad Francisco de Victoria, Madrid, Spain., Urology Department, Hospital Universitario, 12 de Octubre, Madrid, Spain., Penile Curvature Center, São Paulo, Brazil., Urology Department, Città della Salute e della Scienza-Molinette Hospital, University of Turin, Turin, Italy., Department of Urology and Men's Health, St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands., University Hospitals Leuven, Leuven, Belgium., Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK., USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA., Department of Urology, Hospital Universitario Puerta De Hierro-Majadahonda, Madrid, Spain., Andrology Center, Villa Donatello Private Hospital, Florence, Italy., Department of Surgery, Urology Section, University of Catania, Catania, Italy. .