Peyronie’s Disease – What can you do?

Men with Peyronie’s disease have several treatment options available, including traction devices to surgery. Over the years, injections of a substance called clostridium histolyticum (CCH) have become more popular. However, not all men respond well to this therapy, according to new research in the Journal of Sexual Medicine. The study involved with 67 men with Peyronie’s disease who had received CCH injections before coming to the researchers’ clinic. All of the men were having sexual difficulties. Almost half eventually had surgery. The researchers discovered that CCH didn’t appear as effective for men with severe penile curvature or deformities.

For men with Peyronie’s disease, treatment with collagenase clostridium histolyticum (CCH) has become more popular over the years. However, some men respond better to this therapy than others, a situation that prompted a recent Journal of Sexual Medicine study.

What is Peyronie’s?

One of the most common characteristics of Peyronie’s disease is a distinct curve that develops when the penis is erect. This curve is caused by areas of hardened scar tissue (plaques) that form just beneath the surface of the skin. In some cases, the plaques become calcified, hardening further.

With plaques present, the penis becomes less flexible, forming a curve. For some men, the penis takes on an hourglass shape or a “hinge” effect. Sexual intercourse can become quite difficult, and many men experience pain.

In addition to CCH injection therapy, Peyronie’s disease can be treated in several ways, including medications, traction (a device that straightens the penis), and surgery.

In this study, the researchers looked into some of the reasons men might not have success with CCH.

They analyzed information from 67 men with Peyronie’s disease who were patients at their clinic between October 2014 and October 2019. All of the men had received CCH treatments by other urologists before visiting the study clinic, but were having problems with sexual function.

The men had had Peyronie’s disease for an average of 28 months and their average curvature was 69 degrees. (For over 60%, the curve was greater than 60 degrees.) Over 75% of the men had “indent, narrowing, or hourglass” deformities, and about 39% had a hinge effect or instability. Thirty-nine percent of the men had calcifications.

Almost half of the men went on to have surgery. These patients had a greater average curvature than the rest of the group (83 degrees) and were more likely to have hinge deformities.

Overall, the researchers concluded that “patients presenting with persistent bother after CCH treatment had a relatively severe mean curvature of nearly 70 degrees and high rates of narrowing/indentation deformity and calcification.”

The findings may help doctors who counsel men with Peyronie’s disease who are considering CCH injections, the authors said.

The analysis was one of several SMSNA posters that explored treatments for Peyronie’s disease, which is characterized by a curving of the penis, caused by fibrous scar tissue that can make erections painful, and even prevent intercourse when the bend is significant.

“We only treat men with significant bother from the condition, or if they can’t have sex or if sex causes their partner pain,” urologist Tobias Kohler, MD, also of the Mayo Clinic, told MedPage Today.

An expensive option for  Peyronie’s Disease.

In 2013, CCH injections became the first FDA-approved drug treatment for Peyronie’s, indicated for men with palpable plaque and curvature of at least 30 degrees. The treatment costs around $4,000 per injection, with a standard therapeutic course involving eight total injections.

The treatment’s cost has been controversial in urology. Trost, who is now at the Male Fertility and Peyronie’s Clinic in Orem, Utah, suggested that the cost of the medical treatment favorably compares with surgery when surgical complications and rehospitalizations are factored into the equation.

RESOURCES

See more recent news about Peyronie’s disease:

Study: More Men Than Women Bothered by Peyronie’s Disease

Medication and Traction Help Men with Peyronie’s Disease

Peyronie’s Disease: More Men Receiving CCH Injections

Men With Both Peyronie’s Disease and Erectile Dysfunction Have Surgical Options

Resources

Johns Hopkins School of Medicine

“Peyronie’s disease”

https://urology.jhu.edu/peyronie/

The Journal of Sexual Medicine

Bajic, Petar, MD, et al.

“Characteristics of Men With Peyronie’s Disease and Collagenase Clostridium Histolyticum Treatment Failure: Predictors of Surgical Intervention and Outcomes”

(Full-text. Published online: February 29, 2020)

https://www.jsm.jsexmed.org/article/S1743-6095(20)30067-9/fulltext?dgcid=raven_jbs_aip_email