An illustrated description of a modified collagenase Clostridium histolyticum protocol for Peyronie's disease.

Abstract

Background: Our team recently published outcomes of a novel technique for the administration of Collagenase Clostridium histolyticum (CCH), which resulted in improved curvature outcomes and reduced number of CCH injections required.

Aim: To provide a detailed and illustrated description of our CCH-administration technique.

Methods: A descriptive summary is provided of the technique, including drug administration, protocol modifications, and post-treatment protocols. Additional details are provided on measurement techniques and disease classification.

Outcomes: Key outcomes include a written and illustrated description of the injection technique and pre-, and postinjection management.

Results: The use of a modified CCH-administration technique has previously been shown to result in mean improvements of 54%-58% in penile curvature while significantly reducing the total number of injections applied. These findings represent the largest improvements published to date. Key aspects of the technique include back-to-back day administration of 0.9 mg suspended in 0.8 mL, application to an ~3 × 1 cm region, inclusion of the dorsal septum (exempting ventral curves), administration during a full erection (day 1), repeat artificial erections with the first injection of each series, in-office modeling (day 2), and post-treatment use of PDE5s and Restorex traction. Appropriate patient counseling on expectations and necessity of complying with all treatment protocols (including post-treatment wrapping) is critical to optimizing outcomes. Common side effects may include ecchymoses, hematomas, blood blisters, impacts on erections and penile sensation, bronzing of the skin, and skin scarring, while more severe complications are rare (<1%).

Clinical implications: The current manuscript provides a more detailed description of previously published techniques to aid providers in implementation and to mitigate potential adverse events.

Strengths and limitations: Strengths include reliance on the largest single-team series published on CCH outcomes, rigorous study methodology, prospective/sequential series, and step-wise improvements. Limitations include data obtained from a single center.

Conclusion: The current manuscript provides a detailed narrative and illustrated description of our current CCH-administration technique.