Impact of the Advent of Collagenase Clostridium histolyticum on the Surgical Management of Peyronie's Disease: A Population-Based Analysis.

Abstract

Peyronie's disease (PD) is a progressive fibrotic disorder of the penis that can induce pain and erectile dysfunction and has various treatment modalities, including surgical, pharmaceutical, and Clostridium histolyticum injection therapies. The authors used electronic medical records from Kaiser Permanente Southern California, an integrated health care system that consists of 15 medical centers, and identified patients diagnosed with stable PD without concomitant erectile dysfunction from January 1, 2004, to December 31, 2020. Baseline characteristics between surgical and injection groups were compared using Chi-squared and Kruskal-Wallis tests. Multivariable logistic regression with adjustment of confounders was implemented to identify which variables may influence whether patients received injection or surgical therapy. A total of 11,706 patients with PD were identified. The rate of new PD diagnosis per 100,000 patients increased by 0.37 every year, P < .05. The incident rate (per 1000 eligible patients) of surgical management declined on average by 0.40 each year (P < .001), although there was an increase rate of 1.19 for injection therapy (P < .001). On multivariable modeling, patients 45-54 years of age were more likely to receive injection therapy as the primary treatment for PD (adjusted odds ratio = 2.77; P = .002; confidence interval = 1.34-5.73). This study illustrates that pentoxifylline is now more frequently used than colchicine and vitamin E as oral treatments for PD, while collagenase C. histolyticum injection therapy is now more prevalently employed than surgical intervention as the therapeutic approach for PD.