Classic Citations: The use of collagenase in the treatment of Peyronie's disease M.K. Gelbard, A. Lindner, and J.J. Kaufman

Autor: Laurence A. Levine, Sidney Glina, Gerald H. Jordan, Emre Akkus, Martin K. Gelbard
Rok vydání: 2007
Předmět:
Zdroj: The Journal of Sexual Medicine. 4:1209-1213
ISSN: 1743-6095
Popis: G et al. decided to do this phase one study due to the need for an effective medical treatment for Peyronie’s Disease (PD), particularly for “Symptomatic men who are unhappy with their lot but wary of the risks and rigors of a reconstructive operation” [1]. They had shown in a previous study [2] that purified clostridium collagenase in vitro dissolved plaque tissue without any action on elastic tissue, vascular smooth muscle or the myelin. In this classic article, they studied 31 men with mean age of 55.5 (22–67) years with a history of PD for a mean interval of 22.2 (260) months. Ten of them had been submitted to other treatments including radiotherapy and intralesional corticosteroids with no improvement. One patient had undergone an unsuccessful plaque excision and grafting. Mean curvature was 42° (11–190). Fourteen patients still had pain at the beginning of the study and 4 were not able to have intercourse due to pain or penile deformity. Objective evaluation of the curvature was done by “tracing of the erect penis on the vertical and horizontal planes” at the beginning of the study and 4 weeks after treatment. It is not clear in the articler whether this drawing was done at home by the patient or at the office, with any pharmacologic or sexual stimulation. Plaques were measured manually and classified as small or impalpable (less than 8 mm), moderate (8–5 mm) and large (>15 mm). Six, 12, and 13 patients had small, moderate, and large size plaques. Collagenase was injected intralesionally with a 1.0 cc tuberculin syringe with a 23-gauge needle. Injection was done daily for three days under local anesthesia; lidocaine was infiltrated into the injection site in 22 patients and in the remaining 9 patients it was injected into corpora cavernosa. The collagenase was used in concentrations of 470620 mg/mL in the first 15 patients and 910 mg/ml in the remainder. The first six patients received collagenase only, the other 25 received baminopropionitrile fumarate topically (7 patients) or orally (17 patients). This drug was used as an adjuvant therapy due to its ability to prevent fibrosis formation in the healing process. Objective improvement was seen in 20 patients; plaques disappeared or were significantly altered in 4 patients and penile curvature decreased 20–100% in the remaining 16. Pain was eliminated in 13 of the 14 patients. Three out of four regained ability to have penetration. Injections were well tolerated; 21 patients had ecchymosis and two complained of pain. One patient had an albuginea rupture during intercourse two weeks after treatment, which was believed to be collagenase related. Authors commented in the discussion that the main aspect of the study was the ability to prove the safety of intralesional collagenase, even not impairing the possibility to do a surgery on the failure cases, what had happened in two cases of this group. Interestingly, the article was followed by two editorial comments by Leonard M. Zinman and Charles J. Devine who had raised the need for further studies for clarifying long-term results and the possible systemic and immunological effects of the collagenase. Sidney Glina, MD Editor, Classic Citations © 2007 International Society for Sexual Medicine
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