(261) Response to Intralesional Collagenase Clostridium Histolyticum Therapy in Men with Peyronie’s Disease is Independent of Baseline Testosterone Levels

Abstract

Abstract Introduction Testosterone plays an important role in collagen metabolism, TGF-β1 expression, and wound healing, all critical factors in the pathogenesis of Peyronie’s disease (PD). While evidence is mixed, some clinical studies have suggested an association between PD and hypogonadism. Objective We seek to investigate whether baseline total serum testosterone (tT) influences response to intralesional collagenase clostridium histolyticum (CCh) for PD. Methods A retrospective review of patients undergoing CCh injections was conducted at a single institution. Only patients with available tT levels within one year of initial CCh injection were included. Curvature was assessed after in-office intracavernosal injection of vasodilatory agents or patient-provided photograph. Data was collected on baseline demographic characteristics, hypogonadal status, tT, number of CCh cycles, and pre- and post-treatment degree of curvature. Hypogonadism was defined as a tT <300ng/dL, or a documented diagnosis. Results A total of 36 men were included. The mean age was 58.2 years old (SD 10.4) and the mean BMI was 26.8 (SD 3.2). The mean pre-treatment tT was 459.2 ng/dL (SD 144.0), and 14 (39.9%) were hypogonadal. Of hypogonadal men, 5 (35.7%) were receiving hormonal replacement therapy, 4 on testosterone and 1 on clomiphene. Thirty (83.3%) men experienced some degree of erectile dysfunction. The mean pre-treatment curvature was 47.6° (SD 14.2) and the mean post-treatment curvature was 27.8°(SD 10.7), for a mean improvement of 19.9° (40.1%) after an average of 4 cycles (2-8) (Table 1). Baseline tT was not associated with baseline rigidity (β=-0.01; R2=0.02; p=0.41). However, hypogonadal status was significantly associated with more severe curvature, 54.6° among hypogonadal men compared to 43.2° among eugonadal men (p=0.03); however, baseline curvature and tT were not significantly associated (β=-0.03; R2=0.09; p=0.08). On linear regression analysis, tT did not significantly predict improvement in degrees (β=-0.02; R2=0.06; p=0.14; Figure 1) or percent (β=0.0; R2=0.05; p=0.18; Figure 2). Similarly, improvement in neither degrees nor percent differed significantly by hypogonadal status (p=0.14 and p=0.69, respectively). Number of cycles did significantly predict greater improvement in curvature on both univariate and multivariate analyses (β=5.7; R2=0.34; p<0.01). Conclusions While hypogonadism is associated with more severe curvature, neither total testosterone nor hypogonadism is associated with degree of improvement after CCh treatment. Men should be offered CCh therapy according to guidelines independent of gonadal status. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast Clarus Therapeutics Antares Pharma Acerus.