title: Results of SMSNA Survey Regarding Complications Following Intralesional Injection Therapy With Collagenase Clostridium Histolyticum for Peyronie's Disease.
abstract: BACKGROUND
  Intralesional injection of collagenase clostridium histolyticum (CCH) for Peyronie's disease (PD) can result in serious adverse events such as hematoma formation and corporal rupture.
  
  
  OBJECTIVE
  To investigate the prevalence of complications from CCH and management trends among CCH prescribers.
  
  
  METHODS
  A survey was sent to all 693 members of the Sexual Medicine Society of North America (SMSNA) with valid email addresses. Responders were asked to participate if they were prescribers of CCH. Data regarding prescriber experience with CCH, procedural preferences, and rates and management strategies of complications were collected.
  
  
  METHODS
  One hundred SMSNA members completed the survey, with 36%, 23%, and 41% of responders having performed ≤10, 10 to 20, and >20 CCH injections, respectively.
  
  
  RESULTS
  Of the responders, 94% reported hematomas in <25% of patients, with 63% preferring to observe and 37% treated with a combination of observation, application of a compressive dressing, and/or drainage of the hematoma. Corporal ruptures were encountered by 34% of physicians at a median of 5 days (0.5 to 30 days) from the last CCH injection. Rupture was located over the treated plaque in 84% of cases, and surgical intervention was the preferred management option by 67% of members. A distal circumcising degloving incision was used in 76% of cases, and 62% of responders reported the quality of tissue to be worse than would be expected with a non-CCH penile fracture. There were no significant differences in erectile function, ability to have intercourse, change in penile curvature, and patient satisfaction among patients who underwent surveillance vs surgery. One observed patient developed a penile abscess.
  
  
  CONCLUSIONS
  A wide variation exists among SMSNA members' strategies to prevent and manage complications of CCH. One in 3 prescribers reported encountering a corporal rupture during CCH therapy, and it is currently undetermined if there is a benefit of surgery vs conservative management.
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Faysal A
authors.initials: FA
authors.lastname: Yafi
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Anaissie
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Zurawin
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Suresh C
authors.initials: SC
authors.lastname: Sikka
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA. Electronic address: hellst@tulane.edu.
authors.forename: Wayne J G
authors.initials: WJ
authors.lastname: Hellstrom
mesh_terms: D004305:Dose-Response Relationship, Drug; D019538:Health Care Surveys; D006406:Hematoma / Q000139:chemically induced*; D006801:Humans; D015552:Injections, Intralesional / Q000009:adverse effects*; D008297:Male; D003012:Microbial Collagenase / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D009656:North America; D017060:Patient Satisfaction; D010411:Penile Induration / Q000188:drug therapy* / Q000503:physiopathology; D010413:Penis / Q000187:drug effects* / Q000503:physiopathology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012421:Rupture / Q000139:chemically induced; D016896:Treatment Outcome
chemical_list: D003012:Microbial Collagenase
keywords: Collagenase Clostridium Histolyticum; Corporal Fracture; Hematoma; Intralesional Injection Therapy; Peyronie’s Disease; Xiaflex