Presentation Authors: Sriram Eleswarapu*, Arash Amighi, Neil Mendhiratta, Jesse Mills, Los Angeles, CA
Introduction: Clostridium Collagenase histolyticum (CCh) injection into penile plaques is an efficacious treatment for men with Peyronie's disease. Initial clinical trials evaluated a single round of eight injections administered over six months. These men experienced improvement after a single round of treatment; however, most men retained residual curvature after 8 injections. The role of additional rounds of treatment has not been formally examined. We sought to evaluate the role of more than one round of CCh injections in the treatment of men with PD.
Methods: An IRB-approved database of all men undergoing CCh injections by a single surgeon at an academic men's health clinic between 2016 and 2018 was retrospectively evaluated. Doppler ultrasounds and erect penile goniometry were performed before and after each round of eight CCh injections. CCh injection parameters, peak systolic velocities, sonographically measured plaques, curvature data, demographic information, age, comorbidities, and adverse events were abstracted from patients' charts.
Results: A total of 126 men underwent treatment, and 83 received at least one round of eight injections. Fifty-five of these men had follow-up ultrasounds. Forty-two men have finished or are undergoing a second round of CCh therapy (i.e., more than eight injections). Four of these patients have ultrasound measurements before and after 2 rounds of CCh therapy. The average change in curvature after 1 round of CCh in the larger cohort of 55 men was 20.4%. Those with 2 rounds of CCh experienced an average percent change in curvature of 30.1% after 1 round and 50.0% after the 2 rounds of therapy (i.e., 16 total injections) compared to their baseline curvatures.
Conclusions: This study demonstrates that further improvement can be achieved by continuing therapy beyond the standard eight-injection regimen for CCh therapy described in prior clinical trials. It is reasonable to offer additional rounds of CCh injections to men who experience modest improvement but persistent curvature after one round of therapy.