Login to Access Video or Poster Abstract: MP56-08
Sources of Funding: none

Introduction

Peyronie&[prime]s Disease (PD) is a fibrotic disorder affecting the tunica albuginea of the corpora cavernosa. Stepwise intralesional injections of Collagenase Clostridium Histolyticum (CCH) was approved for use in 2013. This study sought to examine a large cohort of men presenting with PD prior to FDA approval of CCH therapy. All patients were carefully staged for reconstructive surgery or penile implant by Color Duplex Ultrasonography.

Methods

A retrospective review was completed of all patients complaining of PD who underwent in office testing with intracavernous pharmacologic erection augmented by visual sexual stimulation and CDDU from 2008 to 2013 by one Urologist. Patients were further characterized by age, BMI, cardiovascular risk factors, co-morbid diagnosis of Dupuytren’s contracture, hypogonadism, self reported ED by Sexual Health Inventory for Men score (SHIM), and prior history of prostate surgery. CDDU characteristics recorded were: peak systolic velocities (PSV) and resistive indices (RI), tunica albuginea plaque characteristics (calcifications), degree and type of penile curvature (dorsal, ventral, lateral, complex).

Results

A total of 451 patients were found to have PD, mean age of 63 years (26-95) and a mean BMI of 27.1 (range 18.1-46.1). 255/451 (56.5%) of patients had a moderate degree of curvature, >30 and <60°. Minor curvature (<30°) was noted in 22.5%. Severe curvature (>60°) was noted in 21%. Of the moderate curvature patients, 84/255 (33%) had normal penile hemodynamic parameters; 25/255 (10%) had arterial insufficiency, 82/255 (32%) had cavernous venous occlusive dysfunction, and 64/255 (25%) patients had mixed vascular disease.

Conclusions

In examining these pre-CCH era presentations, approximately 56% of PD patients presented with moderate penile curvature (>30 and <60°). Xiaflex is indicated for adult men with curvature > 30° and post-marketing studies confirm average curvature improvements of 30-35% or 20°. Using curvature as the only criteria for selection of Xiaflex, one-third of our patients could have been treated with CCH without need for any additional therapy to manage ED (normal Doppler exams). Additional counseling and treatment for men with some degree of erectile dysfunction (abnormal Doppler exams), would be needed to effectively manage the remaining 76% of men following CCH. There remains the need to effectively counsel PD patients with severe curvature and / or moderate curvate with concomitant ED about surgical options for PD.

Funding

none