Improved Peyronie's Disease Curvature Outcomes Using a Novel Collagenase Administration Protocol

Urology. 2022 Dec:170:117-123. doi: 10.1016/j.urology.2022.09.017. Epub 2022 Oct 12.


Objective: To report outcomes of a novel collagenase clostridium histolyticum (CCH) injection protocol.

Methods: A prospective, sequential database was maintained of all Peyronie's men undergoing CCH injections since 2015. Our protocol has evolved to include changes with injection technique, timing, aggressive modeling/traction, and wrapping. Results of the "traditional" and "novel" techniques were compared using two definitions: "most recent" assessment and final assessments among men who "completed eight (injections) or were satisfied."

Results: A total of 509 men underwent greater than or equal to 1 CCH series (traditional, n = 280; novel n = 229). Baseline demographic/clinicopathologic characteristics were similar between groups. Results demonstrated significantly greater curve improvements with the novel technique ("most recent" median 30° vs 20° or 46% vs 28%; "completed eight or satisfied" 34° vs 20° or 58% vs 30%). Using the "completed eight or satisfied" definition, 94% vs 66% of men achieved greater than or equal to 20% improvement (odds ratio 7.6), and 60% vs 24% achieved greater than or equal to 50% improvements (odds ratio 5.0) in the novel cohort (all P < .0001). Importantly, the International Index of Erectile Function Erectile Function Domain score was unchanged, and subjective erectile function (50% vs 5%, P < .0001) and sensation improved (17% vs 8% improved, P = .01) with the new protocol. The novel cohort also reported higher rates of surgery prevention (53% vs 18%), restored/facilitated penetration (57% vs 21%), and hematomas (56% vs 26%), necessitating changes to wrapping procedures (all P < .0001).

Conclusions: Use of the novel CCH protocol results in significant improvements with curvature without negatively impacting erectile function or sensation. Given its specialized nature, it is not recommended for low-volume CCH injectors.

MeSH terms

  • Erectile Dysfunction*
  • Humans
  • Injections, Intralesional
  • Male
  • Microbial Collagenase* / therapeutic use
  • Penile Induration* / drug therapy
  • Penis / drug effects
  • Penis / physiopathology
  • Prospective Studies
  • Treatment Outcome


  • Microbial Collagenase