PD23-01 IMPROVED PEYRONIE’S DISEASE CURVATURE OUTCOMES USING A MORE AGGRESSIVE COLLAGENASE TECHNIQUE

Abstract

You have accessJournal of UrologyCME1 May 2022PD23-01 IMPROVED PEYRONIE’S DISEASE CURVATURE OUTCOMES USING A MORE AGGRESSIVE COLLAGENASE TECHNIQUE Alissa Tyler, Benjamin Green, Joshua Savage, Klinton Brearton, and Landon Trost Alissa TylerAlissa Tyler More articles by this author , Benjamin GreenBenjamin Green More articles by this author , Joshua SavageJoshua Savage More articles by this author , Klinton BreartonKlinton Brearton More articles by this author , and Landon TrostLandon Trost More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002565.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since the FDA approval of Collagenase Clostridium Histolyticum (CCH) for the treatment of Peyronie’s Disease (PD), several investigators have reported outcomes of CCH, with improvements ranging from approximately 15-30%. More recently, we reported improved results (49% mean improvement) when CCH was combined with RestoreX penile traction therapy (RxPTT). Since then, we have made additional modifications to create a more aggressive injection / traction protocol to further optimize outcomes. The objective of the current study was to report outcomes of a more aggressive CCH injection/traction protocol in men with PD. METHODS: A prospective database has been maintained of all individuals undergoing CCH injections since 2014. Our CCH injection protocol has evolved from the one described in the IMPRESS trials to a more aggressive use of injections and manual and mechanical traction. Currently, the protocol consists of injecting 0.9 mg of CCH in 0.7 ml of saline into approximately 15-20 sites around the point of maximal curvature (pharmacologically-induced erection performed with the first injection of each series). Injections are only performed on subsequent days (not 2-3 days apart), and very aggressive (i.e. 10-15 lbs of force) modeling is performed with the 2nd injection. Patients are counseled to begin RestoreX traction at 24-48 hours after the 2nd injection for 30-60 minutes daily, and to continue aggressive manual modeling for at least the first week post injection. Penile wraps are applied for 5 days post injection. A descriptive analysis was subsequently performed to review outcomes. RESULTS: A total of 438 men underwent at least 1 series of CCH and had baseline and follow-up curve assessment data available. Mean age was 55.8, with a mean PD duration of 32 months and a median baseline composite curvature of 64 degrees. Using the definition of most recent curve assessment, mean composite curve improvements were 27.1 degrees (41%) with the new technique vs 17.8 (24.6%, p<0.001). Of men who completed all 8 injections or stopped early due to satisfaction, the mean improvements were 36.4 degrees (59%) vs 19.8 (30.5%, p<0.001). Despite the more aggressive stretching and traction protocol, erectile function was similar to baseline (IIEF-EFD +0.5). CONCLUSIONS: Implementation of a more aggressive CCH injection protocol has resulted in improved curvature outcomes. Given the specialized nature of technique modifications described, these results would argue for a center-of-excellence model for CCH administration to achieve optimal outcomes. Source of Funding: NA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e409 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alissa Tyler More articles by this author Benjamin Green More articles by this author Joshua Savage More articles by this author Klinton Brearton More articles by this author Landon Trost More articles by this author Expand All Advertisement PDF DownloadLoading ...