Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Conservative management of suspected fractures in men undergoing collagenase clostridium histolyticum for Peyronie’s Disease is not associated with worsening of erectile function

International Journal of Impotence Research volume 34, pages 100–107 (2022)Cite this article

Subjects

Abstract

The optimal management of suspected penile fractures post collagenase clostridium histolyticum (CCH) remains indeterminate, with some advocating for observation and others surgical repair. To address this issue, the current study sent surveys to 158 men with Peyronie’s Disease (PD) who completed four CCH injection series. The survey included the Erectile Function Domain from the International Index of Erectile Function (IIEF-EFD) and questions regarding potential symptoms of corporal rupture (hematoma, popping, and detumescence). Men were categorized as having a suspected fracture (SF+) if they reported a popping sensation or rapid detumescence. All SF(+) men were managed conservatively without surgical intervention. Results were compared statistically against baseline IIEF-EFD values and between SF(+) and SF(−) groups. The key study objective was to determine whether erectile function was negatively impacted by conservative management of suspected fractures. Of the 53 returned surveys, 45 had complete data for review. The sample was statistically representative of the broader cohort of 158 men, except being older (60.0 vs 57.1 [SD 6.0 vs 9.0], p = 0.01) with shorter durations of PD (median 9 [IQR 5, 19] mo vs 13 [IQR 8, 24], p = 0.01). Overall, 7/45 (16%) of men were defined as SF(+), with all fractures occurring within 6 weeks of CCH administration. No demographic or pathophysiologic characteristics predicted SF(+). Importantly, SF(+) men did not experience worsened erectile function compared to SF(−), with a median IIEF-EFD change of +2 vs +1, p = 0.16, respectively. Curvatures were improved to a greater degree among SF(+) men (primary: median −30 [IQR −20, −32.5] vs −15 [−5, −26], p = 0.04; composite: −35 [−25, −40] vs −25 [−7, −30], p = 0.15). We concluded that suspected penile fractures in PD men undergoing CCH may be reasonably managed without surgical intervention and portend greater improvements in curvature correction.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flow diagram for study cohort.
Fig. 2: Bar graph demonstrating erectile function between study cohorts.

Similar content being viewed by others

References

  1. Lindsay MB, Schain DM, Grambsch P, Benson RC, Beard CM, Kurland LT. The incidence of Peyronie’s disease in Rochester, Minnesota, 1950 through 1984. J Urol. 1991;146:1007–9.

  2. Dibenedetti DB, Nguyen D, Zografos L, Ziemiecki R, Zhou X. A population-based study of peyronie’s disease: prevalence and treatment patterns in the United States. Adv Urol. 2011;2011:282503.

    Article  Google Scholar 

  3. Schwarzer U, Sommer F, Klotz T, Braun M, Reifenrath B, Engelmann U. The prevalence of Peyronie’s disease: results of a large survey. BJU Int. 2001;88:727–30.

    Article  CAS  Google Scholar 

  4. Rhoden EL, Teloken C, Ting HY, Lucas ML, Teodosio da Ros C, Ary Vargas Souto C. Prevalence of Peyronie’s disease in men over 50-y-old from Southern Brazil. Int J Impot Res. 2001;13:291–3.

    Article  CAS  Google Scholar 

  5. La Pera G, Pescatori ES, Calabrese M, Boffini A, Colombo F, Andriani E, et al. Peyronie’s disease: prevalence and association with cigarette smoking. A multicenter population-based study in men aged 50-69 years. Eur Urol. 2001;40:525–30.

    Article  Google Scholar 

  6. Mulhall JP, Creech SD, Boorjian SA, Ghaly S, Kim ED, Moty A, et al. Subjective and objective analysis of the prevalence of Peyronie’s disease in a population of men presenting for prostate cancer screening. The J Urol. 2004;171:2350–3.

    Article  Google Scholar 

  7. Nehra A, Alterowitz R, Culkin DJ, Faraday MM, Hakim L, Heidelbaugh J, et al. Peyronie’s disease: AUA guideline: AUA; 2015. www.auanet.org/education/guidelines/peyronies-disease.cfm.

  8. Yafi FA, Diao L, DeLay KJ, DeYoung L, Talib R, Alzweri L, et al. Multi-institutional prospective analysis of intralesional injection of collagenase clostridium histolyticum, tunical plication, and partial plaque excision and grafting for the management of Peyronie’s Disease. Urology. 2018;120:138–42.

    Article  Google Scholar 

  9. Cocci A, Russo GI, Salonia A, Cito G, Regis F, Polloni G, et al. Predictive factors of patients’ and their partners’ sexual function improvement after collagenase clostridium histolyticum injection for peyronie’s disease: results from a multi-center single-arm study. J Sex Med. 2018;15:716–21.

    Article  Google Scholar 

  10. Nguyen HMT, Anaissie J, DeLay KJ, Yafi FA, Sikka SC, Hellstrom WJG. Safety and efficacy of collagenase clostridium histolyticum in the treatment of acute-phase Peyronie’s Disease. J Sex Med. 2017;14:1220–5.

    Article  Google Scholar 

  11. Yang KK, Bennett N. Peyronie’s disease and injectable collagenase clostridium histolyticum: safety, efficacy, and improvements in subjective symptoms. Urology. 2016;94:143–7.

    Article  Google Scholar 

  12. Ziegelmann MJ, Viers BR, McAlvany KL, Bailey GC, Savage JB, Trost LW. Restoration of penile function and patient satisfaction with intralesional collagenase clostridium histolyticum injection for Peyronie’s Disease. J Urol. 2016;195:1051–6.

    Article  Google Scholar 

  13. Hellstrom WJG, Tue Nguyen HM, Alzweri L, Chung A, Virasoro R, Tapscott A, et al. Intralesional collagenase clostridium histolyticum causes meaningful improvement in men with Peyronie’s disease: results of a multi-institutional analysis. J Urol. 2019;201:777–82.

    Article  Google Scholar 

  14. Gelbard M, Goldstein I, Hellstrom WJ, McMahon CG, Smith T, Tursi J, et al. Clinical efficacy, safety and tolerability of collagenase clostridium histolyticum for the treatment of peyronie disease in 2 large double-blind, randomized, placebo controlled phase 3 studies. J Urol. 2013;190:199–207.

    Article  CAS  Google Scholar 

  15. Yafi FA, Anaissie J, Zurawin J, Sikka SC, Hellstrom WJ. Results of SMSNA survey regarding complications following intralesional injection therapy with collagenase clostridium histolyticum for Peyronie’s Disease. J Sex Med. 2016;13:684–9.

    Article  Google Scholar 

  16. Esposito AA, Giannitto C, Muzzupappa C, Maccagnoni S, Gadda F, Albo G, et al. MRI of penile fracture: what should be a tailored protocol in emergency? La Radiologia Med. 2016;121:711–8.

    Article  Google Scholar 

  17. Wymer K, Ziegelmann M, Savage J, Kohler T, Trost L. Plaque calcification: an important predictor of collagenase clostridium histolyticum treatment outcomes for men with Peyronie’s disease. Urology. 2018;119:109–14.

    Article  Google Scholar 

  18. Alom M, Meng Y, Sharma KL, Savage J, Kohler T, Trost L. Safety and efficacy of collagenase clostridium histolyticum in peyronie’s disease men with ventral curvatures. Urology. 2019;129:119–25.

    Article  Google Scholar 

  19. Alom M, Sharma KL, Toussi A, Kohler T, Trost L. Efficacy of combined collagenase clostridium histolyticum and restorex penile traction therapy in men with Peyronie’s disease. J Sex Med. 2019;16:891–900.

    Article  Google Scholar 

  20. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822–30.

    Article  CAS  Google Scholar 

  21. Saglam E, Tarhan F, Hamarat MB, Can U, Coskun A, Camur E, et al. Efficacy of magnetic resonance imaging for diagnosis of penile fracture: A controlled study. Investig Clin Urol. 2017;58:255–60.

    Article  Google Scholar 

  22. Rosen RC, Allen KR, Ni X, Araujo AB. Minimal clinically important differences in the erectile function domain of the International Index of Erectile Function scale. Eur Urol. 2011;60:1010–6.

    Article  Google Scholar 

  23. Amer T, Wilson R, Chlosta P, AlBuheissi S, Qazi H, Fraser M, et al. Penile fracture: a meta-analysis. Urol Int. 2016;96:315–29.

    Article  Google Scholar 

  24. Ortac M, Ozgor F, Caglar U, Esmeray A, Savun M, Sarilar O. Older age and a large tunical tear may be predictors of increased erectile dysfunction rates following penile fracture surgery. Int J Impot Res. 2019;32:226–31.

    Article  Google Scholar 

Download references

Acknowledgements

The authors wish to acknowledge the generous donation of an anonymous benefactor which provided the necessary funds to conduct this study.

Author information

Author notes

  1. These authors contributed equally: Kiran L. Sharma, Raevti Bole

Authors and Affiliations

  1. Department of Urology, Mayo Clinic, Rochester, MN, USA

    Kiran L. Sharma, Raevti Bole, David Yang, Manaf Alom, Matthew Ziegelmann & Landon Trost

  2. Male Fertility and Peyronie’s Clinic, Orem, UT, USA

    Joshua Savage & Landon Trost

Authors
  1. Kiran L. Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Raevti Bole
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Manaf Alom
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joshua Savage
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Matthew Ziegelmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Landon Trost
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Landon Trost.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sharma, K.L., Bole, R., Yang, D. et al. Conservative management of suspected fractures in men undergoing collagenase clostridium histolyticum for Peyronie’s Disease is not associated with worsening of erectile function. Int J Impot Res 34, 100–107 (2022). https://doi.org/10.1038/s41443-020-00383-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-020-00383-7

Search

Advanced search

Quick links