CCH vs surgery: Which is a better treatment for Peyronie’s disease?

Men with Peyronie’s disease (PD) who received Clostridium histolyticum (CCH) + RestoreX penile traction therapy + sildenafil have lesser curve improvements but better penile length and fewer adverse events (AEs) at 3 months compared to those treated with surgery, results of a recent study have shown.

“PD men with ≥30 ° curvature who undergo treatment with CCH experience lesser curvature improvements but greater overall orgasmic function, penile length, subjective erectile function, and penile sensation compared to surgery,” the researchers said.

In this randomized, controlled trial, PD men were assigned to receive either collagenase CCH + RestoreX penile traction therapy + sildenafil or penile surgery + RestoreX penile traction therapy + sildenafil. The research team then assessed 3-month data.

The primary outcomes assessed were overall satisfaction, subjective changes in erectile function, penile sensation, penile length, and changes in the International Index of Erectile Function–Erectile Function Domain (IIEF-EFD) score. Secondary outcomes included objective changes in length, curve, AEs, and other standardized and nonstandardized questionnaires.

Forty men participated in the study, of whom 38 (CCH: n=19; surgery: n=19) competed treatment and had available 3-month data. Demographic and clinicopathological variables were comparable between the two treatment arms. [J Urol 2023;210:791-802]

Half of the men in the CCH group reported being very satisfied (50 percent vs 21 percent in the surgery group; p=0.08) and had better subjective erectile function (100 percent vs 68 percent; p=0.03) and penile length (88 percent vs 16 percent; p<0.0001) after treatment.

Moreover, the CCH group also experienced lesser impacts on penile sensation (75 percent vs 11 percent; p<0.001) and showed similar IIEF-EFD changes (1.5 vs 2.5; p=0.91) compared to the surgery group.

On the other hand, men who underwent surgery showed greater curve improvements (84 percent vs 54 percent; p<0.01) and experienced more AEs (50 vs 13 events; p<0.001) and decreased penile length (‒0.5 vs 1.0 cm; p<0.01).

“With the exception of penile discoloration, surgery men had higher rates of all AEs, including penile pain, length loss, swelling, palpable lumps, loss/abnormal penile sensation, and other events,” the researchers said.

A common reason for undergoing surgery instead of CCH in PD men was that the procedure could address indentation, hourglass, or other similar deformities. The current data, however, did not support such a differentiation. [J Sex Med 2020;17:1005-1011]

On further analysis, 10 men reported 0s on questions 1 to 5 of the IIEF, indicating either very poor erectile function or the inability to penetrate due to severe curvature. At 3 months, only four of these men continued to have 0s.

“Because the IIEF-EFD is not able to distinguish between true improvements in erectile function and improvements in curvature which restore penetration, these data highlight its limited utility (and underscore its lack of validation) in moderate/severe PD populations,” the researchers said.