title: Surgical correction of persistent Peyronie's disease following collagenase clostridium histolyticum treatment.
abstract: BACKGROUND
  Collagenase clostridium histolyticum (CCH) is an Food and Drug Administration-approved intralesional injection for treatment of Peyronie's disease (PD) that has been shown to reduce penile curvature deformity and PD symptom bother in phase 2b and phase 3 placebo-controlled clinical trials. For some patients, nonsurgical treatment with CCH may not sufficiently improve penile curvature, and surgical correction may be pursued following CCH therapy.
  
  
  OBJECTIVE
  This study aims to examine intraoperative and postsurgical outcomes of surgical correction of persistent penile curvature in patients with PD who had previously received CCH.
  
  
  METHODS
  Retrospective chart review was used to identify patients with PD who had received CCH intralesional injection within either the phase 2b or phase 3 CCH clinical trials and then underwent surgical correction due to remaining penile curvature. Surgical techniques used were partial plaque excision and grafting (PEG) and/or tunica albuginea plication (TAP).
  
  
  METHODS
  Primary assessments included pre- and postsurgery penile curvature, erectile rigidity, stretched penile length, intraoperative time, and occurrence of adverse events.
  
  
  RESULTS
  Seven men were identified who underwent surgical straightening with TAP or PEG following CCH treatment. Mean number of days from the final CCH injection to surgery was 182 (standard deviation 118; median 127 days). Average penile curvature prior to surgical straightening was 58°. No anatomical difficulties or complications secondary to the effects of prior CCH treatment occurred during surgery. Intraoperative time was representative of standard TAP and PEG surgeries (range 88-146 minutes). All men reported penile curvature <20° postsurgery. One patient experienced a postsurgery subgraft hematoma that required aspiration. There were no postsurgery reports of decreased penile sexual sensation and no occurrence of vascular compromise or decreased penile rigidity.
  
  
  CONCLUSIONS
  This initial case series supports the hypothesis that prior CCH treatment is not a contraindication to PEG or TAP surgery in the treatment of penile curvature in patients with PD.
authors.affiliation: Department of Urology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Laurence A
authors.initials: LA
authors.lastname: Levine
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Larsen
mesh_terms: D000368:Aged; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D047009:Hathewaya histolytica / Q000201:enzymology; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008499:Medical Records; D003012:Microbial Collagenase / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D017060:Patient Satisfaction; D010411:Penile Induration / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D010413:Penis / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects
chemical_list: D003012:Microbial Collagenase
keywords: Collagenase Clostridium Histolyticum; Penile Curvature; Peyronie's Disease; Surgery; Treatment