AB20. Non-surgical treatment of peyronie’s disease: a 2014 update

Abstract: Peyronient of Urology, Schoolaracterized by the formation of fibrous plaque in the tunica albuginea of the penis. The patient usually complains of penile deformities in the form of curvature, palpable plaques, hourglass deformity, shortening or indentation with or without pain. The patient might also suffer from erectile dysfunction. The disease is associated with significant mental morbidity as 48% of the patients are clinically depressed. In addition, several comorbidities were found to be associated with the disease, such as diabetes mellitus, hypertension, erectile dysfunction, low testosterone, obesity, and smoking. Furthermore, 20% of patients were found to have Dupuytren by the formation.

This presentation summarizes the current literature pertaining to all pharmacotherapies (oral, intralesional, iontophoresis, and topical) and minimally invasive treatments available for PD (vacuum, traction device, shock wave therapy, and radiation treatment). Special emphasis will be on the recently FDA approved collagenase (Xiaflex). Clostridial collagenases’ ability to digest native, triple-helical types I, II, and III collagens into a mixture of small peptides is its primary distinguishing factor. This is accomplished by making multiple scissions in the triple helix. Digestion is completed by hydrolyzing those fragments into a mixture of small peptides. Conversely, vertebrate collagenases initiate collagenolysis by making a single scission across all three alpha chains after which attack on those alpha chains is very limited.

Two phase 3 studies: IMPRESS (Investigation for Maximal Peyronie’s Reduction Efficacy and Safety Studies) I (417 men) and II (415 men) confirm the efficacy and safety. Men treated with collagenase clostridium histolyticum (CCH) showed a mean 34% improvement in penile curvature, representing a -17.0 ±14.8 degree change per subject, compared with a mean 18.2% improvement in placebo treated men, representing a -9.3±13.6 degree change per subject (P<0.0001). The mean change in Peyronie disease symptom bother score was significantly improved in treated men vs men on placebo (-2.8±3.8 vs. -1.8±3.5, P=0.0037). Three serious adverse events (corporeal rupture) were surgically repaired. We currently employ CCH in our practice as a first line therapy for stable PD with dorsal or dorsal-lateral.

Keywords: Non-surgical treatment; peyronie’s disease; PD