Baseline penile curvature predicts improvement in Peyronie's disease treated with CCH

In men with Peyronie’s disease (PD) treated with intralesional collagenase clostridium histolyticum (CCH), those with greater baseline curvature are more likely to achieve improvement, reaching up to 60 percent for patients with ≥60 degrees, a study has shown.

Data of PD patients treated with CCH up to eight injections, divided into four cycles between January 2014 and July 2020, were retrospectively obtained. The authors assessed penile curvature at baseline and after the second and fourth CCH cycle, per protocol.

If penile curvature did not improve after the second cycle, or if it was significantly improved and the patient was happy, no further treatment was suggested. However, if curvature was significantly improved but the patient was still not satisfied, four cycles were completed.

The authors evaluated three categories of response, namely improvement (≥10 degrees or ≥20 percent, either one happens), unchanged (±10 degrees or ±20 percent), or worsened (≥10 degrees or ≥20 percent, either one happens). They also assessed the factors associated with penile curvature improvements through logistic regression analyses.

Of the 114 patients who underwent CCH treatment (median age 57 years, median PD duration 11 months, mean curvature 47 degrees), 65 percent had dorsal curvature, 53 percent mid-shaft location, and 15 percent calcification.

The mean final curvature following CCH treatment was 40 degrees. Of the patients, 44 percent achieved curvature improvement, 39 percent remained unchanged, and 17 percent worsened after treatment. The mean curvatures decreasing in degrees and percentage among those with curvature improvement were 22 degrees and 41 percent, respectively.

Improvement was more common among men with greater baseline curvature, with percentages of 29 percent in those with baseline curvature ≤30 degrees, 43 percent with 31‒59 degrees, and 60 percent with ≥60 degrees. Baseline curvature was the only significant predictor of improvement following CCH treatment (odds ratio, 1.33, 95 percent confidence interval, 1.1‒1.7).

“We confirmed baseline penile curvature is the most important predictive factor, and this is the first report describing proportions of penile curvature improvement with CCH treatment,” the authors said.