(168) Downgrading Surgical Recommendations After Intralesional Injections of Collagenase Clostridium Histolyticum in Peyronie’s Disease Patients

Abstract

Abstract Introduction After patients undergo intralesional injections of collagenase clostridium histolyticum (CCH) as a primary treatment for Peyronie’s disease (PD), they may have residual curvature and may opt for secondary treatment with surgery. On the other hand, the initial severity of curvature may be best addressed by plaque incision and grafting (PIG), but the surgeon may offer CCH with the intent that post-CCH curvature can be treated with a penile plication (PP) rather than a PIG. Objective Our study investigated the group of PD patients who had their surgical recommendations downgraded from a plaque incision and grafting (PIG) to penile plication (PP), a less complicated procedure, after receiving CCH. Methods Our retrospective, single institution chart review included patients from 2016 to 2022 who underwent surgery to treat PD. We then looked at patients who underwent CCH then PP, and compared those who were initially recommended PIG before CCH to those who were initially recommended PP. Functional penile length was also evaluated as the length of the erect penis, from the base of the pubis to the tip of the glans, in a straight line while disregarding any curvature. Results Our study included 53 men who underwent surgery for treatment of PD, with mean age 56.0 (SD 11.3) at presentation. Of the 24 patients who underwent CCH, their pre-CCH and post-CCH surgery recommendations were: PP then PP in 5 patients (21%), PIG then PP in 11 (46%), PIG then PIG in 8 (33%) (Figure 1). The PIG then PP recommended group had a pre-CCH primary curvature range of 30 to 64 degrees, and post-CCH range of 16 to 46 degrees (Table 1). These patients had no significant difference in operative duration, difficulty, functional penile length, or complications (Table 2). The PIG then PP recommended group had 5 patients (46%) who reported functional residual curves that were manage conservatively, which was not significantly different from the PP then PP recommended group (0 patients, 0%, p=0.08). Conclusions Intralesional injections of CCH helped to downgrade surgical recommendations from the more drastic PIG to the simpler PP in a subset of PD patients, without compromising operative difficulty or postoperative outcomes. This finding is encouraging given that PP can be performed in a shorter operative time, by less experienced surgeons, and with lower risk of postoperative sensation and erectile issues. Disclosure No.