Collagenase Clostridium histolyticum for Peyronie's disease: a contemporary atlas of complications and their management

Thiago P Furtado; Vadim Osadchiy; Juan J Andino; Sriram V Eleswarapu; Jesse N Mills

doi:10.1093/sxmrev/qeae004

Collagenase Clostridium histolyticum for Peyronie's disease: a contemporary atlas of complications and their management

Sex Med Rev. 2024 Mar 15:qeae004. doi: 10.1093/sxmrev/qeae004. Online ahead of print.

Authors

Thiago P Furtado¹, Vadim Osadchiy¹, Juan J Andino¹, Sriram V Eleswarapu¹, Jesse N Mills¹

Affiliation

¹ Division of Andrology, Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, United States.

PMID: 38491199
DOI: 10.1093/sxmrev/qeae004

Abstract

Introduction: Collagenase Clostridium histolyticum (CCH) remains the only Food and Drug Administration-approved medical treatment for Peyronie's disease (PD). The initial IMPRESS I and II trials (Investigation for Maximal Peyronie's Reduction Efficacy and Safety), which led to Food and Drug Administration approval, revealed a rate of treatment-related adverse events as high as 84%. Studies fail to provide clear definitions of complications.

Objectives: To review complications, provide a CCH complication atlas, and propose management strategies for commonly encountered complications.

Methods: We performed a literature review using PubMed. A photographic atlas was provided regarding complications in patients in a high-volume CCH center for PD.

Results: Complications were identified and classified by nature and severity. We followed a standardized previously published grading system for hematomas. Complications include bruising, swelling, hematoma formation, back pain, and, rarely, corporal rupture. Complications were discussed, and hematomas were graded by penile surface area. Complication photographs were graded and displayed. Treatment-related adverse effects do not affect overall results.

Conclusion: Recognizing and grading complications associated with CCH therapy for PD is crucial for effective patient management and informed decision making. A standardized grading system allows for consistency in reporting and comparing hematoma complication rates across studies and patient populations. Herein we provide images that will help clinicians identify and confidently manage common complications that may occur in any CCH program.

Keywords: Peyronie’s disease; Xiaflex; atlas; collagenase Clostridium histolyticum; complications; penile injections.