Advertisement

Plaque Calcification: An Important Predictor of Collagenase Clostridium Histolyticum Treatment Outcomes for Men With Peyronie's Disease

      Abstract

      Objective

      To compare outcomes of men with or without calcified plaques undergoing collagenase Clostridium histolyticum (CCH) injections for Peyronie's disease (PD) and identify predictors of CCH success.

      Materials and Methods

      From March 2014 through January 2017, data were prospectively collected on 192 patients who underwent 1-4 cycles of CCH for the treatment of PD. Of these, 115 completed ≥2 CCH cycles and had data on curvature assessment. The primary outcome was the percentage of men with >20% improvement in composite curvature. Univariate analysis was performed to compare rate of success based on patient and disease characteristics, and multivariate logistic regression was used to identify predictors of successful treatment.

      Results

      Calcified plaques were identified in 34 of 115 (30%) patients. Patients with calcified plaque were younger, had longer duration of disease, and higher rates of significant erectile dysfunction. On multivariate logistic regression controlling for calcification and degrees composite curvature, noncalcified plaque (odds ratio 2.50; 95% confidence interval 1.06-6.00; P = .03) and curvature ≥60° (odds ratio 5.01; 95% confidence interval 1.34-21.62; P = .02) were found to be significant predictors of ≥20% improvement in composite curvature. When differentiated by calcification severity, those with no calcification achieved significant improvements in curvature (28.1° vs 10.3°, P = .04), compared to moderate (shadowing) or severe (>1 cm).

      Conclusion

      Plaque calcification is associated with a significantly lower rate of success of CCH therapy for PD, while greater baseline curvature is associated with increased odds of successful curvature improvement.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ziegelmann MJ
        • Viers BR
        • McAlvany KL
        • et al.
        Restoration of penile function and patient satisfaction with intralesional collagenase Clostridium histolyticum injection for Peyronie's disease.
        J Urol. 2016; 195: 1051-1056
        • Carson CC
        • Levine LA
        Outcomes of surgical treatment of Peyronie's disease.
        BJU Int. 2014; 113: 704-713
        • Nehra A
        • Alterowitz R
        • Culkin DJ
        • et al.
        Peyronie's disease: AUA guideline.
        J Urol. 2015; 194: 745-753
        • Gelbard M
        • Goldstein I
        • Hellstrom WJG
        • et al.
        Clinical efficacy, safety and tolerability of collagenase Clostridium histolyticum for the treatment of peyronie disease in 2 large double-blind, randomized, placebo controlled phase 3 studies.
        J Urol. 2013; 190: 199-207
        • Gelbard M
        • Lipshultz LI
        • Tursi J
        • et al.
        Phase 2b study of the clinical efficacy and safety of collagenase Clostridium histolyticum in patients with Peyronie disease.
        J Urol. 2012; 187: 2268-2274
        • Vande Berg JS
        • Devine CJ
        • Horton CE
        • et al.
        Mechanisms of calcification in Peyronie's disease.
        J Urol. 1982; 127: 52-54
        • Levine L
        • Rybak J
        • Corder C
        • et al.
        Peyronie's disease plaque calcification-prevalence, time to identification, and development of a new grading classification.
        J Sex Med. 2013; 10: 3121-3128
        • Lipshultz LI
        • Goldstein I
        • Seftel AD
        • et al.
        Clinical efficacy of collagenase Clostridium histolyticum in the treatment of Peyronie's disease by subgroup: results from two large, double-blind, randomized, placebo-controlled, phase III studies.
        BJU Int. 2015; 116: 650-656
        • Breyer BN
        • Shindel AW
        • Huang Y-C
        • et al.
        Are sonographic characteristics associated with progression to surgery in men with Peyronie's disease?.
        J Urol. 2010; 183: 1484-1488
        • Bekos A
        • Arvaniti M
        • Hatzimouratidis K
        • et al.
        The natural history of Peyronie's disease: an ultrasonography-based study.
        Eur Urol. 2008; 53: 644-650
        • Chung A
        • Macario A
        • El-Sayed YY
        • et al.
        Cost-effectiveness of a trial of labor after previous cesarean.
        Obstet Gynecol. 2001; 97: 932-941
        • Hatzimouratidis K
        • Eardley I
        • Giuliano F
        • et al.
        EAU guidelines on penile curvature.
        Eur Urol. 2012; 62: 543-552
        • Cordon BH
        • Hofer MD
        • Hutchinson RC
        • et al.
        Superior cost effectiveness of penile plication vs intralesional collagenase injection for treatment of Peyronie's disease deformities.
        Urol Pract. 2017; 4: 118-125

      Linked Article