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MP65-08 INTRALESIONAL INJECTION OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM FOR THE MANAGEMENT OF PEYRONIE’S DISEASE WITH INDENTATION OR HOURGLASS DEFORMITY

INTRODUCTION AND OBJECTIVES: Intralesional injection (ILI) of collagenase Clostridium histolyticum (CCH) is the only Food and Drug Administration approved medical treatment for the management of stable phase Peyronie’s disease (PD). To date, however, there are no published reports specifically examining outcomes of treatment in patients with PD and significant indentation or hourglass deformity. We sought to assess outcomes in patients receiving ILI CCH for these specific deformities. METHODS: We conducted a retrospective review of 13 patients with PD and significant indentation or hourglass deformity who began ILI CCH between November 2016 and June 2018. A penile duplex Doppler ultrasound (PDDU) was performed prior to initiation of therapy in all patients. Degree of curvature was measured at the time of PDDU, after the second cycle, and 4-6 weeks after completion of the fourth cycle. Patients were called after completing treatment and asked whether or not they were satisfied with their injections and if they would pursue this treatment again. Patients answered the symptom bother domain of the Peyronie’s Disease Questionnaire (PDQ) and were scored on a scale of 0-16 before, during and after treatment. RESULTS: Mean age was 52.9 ± 12.6 years. Nine patients (69.2%) had significant indentation and four patients (30.8%) had an hourglass deformity. Mean pre-operative curvature was 48.1° ± 15.9. Mean number of injections was 7.2 ± 2.9, median 6 (range 2-12). Overall, 7.7% completed 2 injections, 7.7% 4 injections, 7.7% 5 injections, 30.8% 6 injections, 23.1% 8 injections, 7.7% 10 injections, and 15.4% 12 injections. Mean change in curvature was -11.2° ± 9.4 (20.4% ± 14.2) and 53.8% of patients had significant ≥20% improvement in curvature. Mean change in PDQ Bother score was -6.80 ± 2.86. Overall, 55.5% reported subjective resolution of their indentation and 75.0% reported significant improvement in hourglass deformity. Responders were satisfied with treatment (100%) and said they would pursue this treatment again (80%). One patient successfully completed 8 injections and reported resolution of indentation, but ultimately sustained a penile fracture which required surgical repair. No other complications were reported in the remaining patients. CONCLUSIONS: Patients with PD and significant indentation or hourglass deformity demonstrate favorable improvements in penile curvature and bother. Resolution or improvement of indentation and/or hourglass deformity can be attained in certain patients. ILI CCH indications could be expanded to include patients with these deformities. Source of Funding: none