Dr. Trost on repeat curve assessments for CCH injections in Peyronie’s disease

Commentary
Video

"If you don't do a repeat curve assessment with each series of injections, you're possibly going to be missing the best location to do the injections," says Landon Trost, MD.

In this video, Landon Trost, MD, highlights the background and key findings from the study, “Changes in point of maximal curvature during collagenase clostridium histolyticum injections for Peyronie’s disease,” for which he served as the senior author. Trost is the founder and director of the Male Fertility and Peyronie’s Clinic in Orem, Utah.

Video Transcript:

Could you describe the background of this study?

Xiaflex is an injectable treatment for Peyronie's disease. [In] the original clinical studies [that] were done, they basically said, "go ahead and do a measurement the first time you do a curve assessment, and then that's going to be the point that you're going to inject each time." As time has gone on, it's been a question of is there a better way to administer the drug? Some people would feel for a palpable plaque. Some people would look at doing ultrasound-guided injections, and things along those lines. Several years back, we realized that sometimes these curves move. So, we started doing curve assessments more regularly. We realized that even though they started with their curve maybe 1 or 2 centimeters from the rim of the head of the penis, after a while, it may have moved 3 centimeters back, or something along those lines. We realized early on that if you kept injecting that same spot every time, you may have gotten some initial benefits, but may have lost some of that efficacy longer term. So, we started doing curve assessments every time we did a Xiaflex injection with the first injection of each series. And then we would administer the medicine to the point of max curve. So, when you do the erection, wherever is most curved, that's where we would do the injections. This clinical study is looking at those outcomes of seeing how much does that point of max curve move or change throughout a treatment course? And are there any predictors to see who's going to change and who's not going to change?

What were some of the notable findings, and were any of those particularly surprising?

I would say the whole thing was pretty surprising to us, just because it does show that indeed, the curve moves. If you don't do a repeat curve assessment with each series of injections, you're possibly going to be missing the best location to do the injections. Key findings we found were that, basically, depending on your direction of curve, you're going to be more likely to move. Down curves, for example, were much more likely to change. This is true whether it was Peyronie's disease or potentially even congenital penile curvature. Then also, curves that were further to the back were more likely to be measured differently each time. So, if someone comes in with a down curve that's 5 centimeters back, that person absolutely needs to have a repeat curve assessment performed every time. If they have one that's like maybe 2 centimeters from the head of the penis, they're a little less likely for it to move throughout the course of the treatment.

This transcription has been edited for clarity.

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