Regain of penile length not seen with collagenase clostridium histolyticum treatment

Among patients with Peyronie’s disease who respond to collagenase clostridium histolyticum (CCH, Xiaflex) injections, there does not appear to be a significant regain of penile length.1

The finding was reported at the 2021 Sexual Medicine Society of North America Fall Scientific Meeting by investigators led by Jacob W. Greenberg of Tulane University School of Medicine, New Orleans, Louisiana, who worked on the study with Wayne J.G. Hellstrom, MD, FACS, and colleagues.

In the study, investigators conducted a post-marketing analysis to determine whether there was significant improvement of stretched penile length, erect penile length, and erect circumference in patients who respond to CCH compared with those who do not. The study included consecutive patients who received treatment with CCH for dorsal plaque and penile curvature above 30°in the absence of hourglass deformity.

A total of 148 patients were analyzed, completing 4 cycles of non-surgical intervention. To assess penile curvature, a goniometer was used after induction of artificial erection using alprostadil. This occurred before treatment and 8 weeks after the end of the fourth cycle. Stretched length, erectile length, and erectile circumference were also measured in the same setting.

“Based on the results of the IMPRESS trial, we decided that any improvement over 15 degrees was deemed a positive response (given our initial measurements were in increments of 5 degrees),” wrote the authors.

Of the 148 patients in the study, 129 (87%) had an improvement over 15° after completing 8 injections of CCH. The average penile curvature, stretched penile length, erected penile length, and erected circumference prior to the treatment were 61.4°, 13.9 cm, 13.3 cm, and 11.8 cm respectively.

Although there was no significant change in the erect or the stretched penile length in patients who responded to the injections, results showed that there was a significant decrease in the erect circumference among the majority of patients (11.8 cm decreasing to 9.3 cm).

The authors concluded, “There appears to be no significant regain of the penile length in which patients often complain about losing due to Peyronie's disease in those who respond to Xiaflex injections. The study finding suggests that the erect circumference might decrease, not necessarily due to the injection itself but due to the disease or recovery process.”

Reference

1. Greenberg JW, Soubra A, Kim J, et al. Xiaflex treatment for Peyronie’s disease may improve penile curvature degree with no effect on the loss on penile length in post-marketing analysis. Paper presented at 2021 Sexual Medicine Society of North America Annual Meeting; October 21-24, 2021. Abstract 069.