penile traction does not improve outcomes with collagenase ...penile traction does not improve...

©2015 MFMER | slide-1

Penile Traction Does Not Improve Outcomes with Collagenase Clostridium Histolyticum for the

Treatment of Peyronie’s Disease

Matthew Ziegelmann*, Boyd Viers, Brian Montgomery, Ross Avant,

Josh Savage, Landon Trost

Mayo Clinic

Department of Urology

Rochester, MN

SMSNA Fall Scientific Meeting

November 6, 2016

Scottsdale, AZ


Introduction

• Penile Traction for PD

• Monotherapy

• Concurrent therapy (surgery, intralesional injections)

• Collagenase clostridium histolyticum?


OBJECTIVE

• Evaluate our experience and outcomes in men undergoing concurrent penile traction with CCH

• Penile curvature improvement

• SPL

• Restoration of penetrative intercourse

• Prevention of surgery


Methods and materials

• CCH treatment for PD between March 2014 and July 2016

• Prospectively maintained database

• CCH

• Manual modeling

• PTT – recommended 3 hrs/day

• Patient reported utilization (hours per day, days per week)

• Andropenis® (Andromedical America-Asia; New York)

• Follow-up

• Patient questionnaires (subjective outcomes)

• Repeat final (+/- interval) curve assessment

• Statistical analysis


Results

Series 1

120 patients

Total Cohort:

120 patients

Series 3

80 patients

Series 2

109 patients

Series 4

65 patients

Objective Follow-up:

51 patients


Results: baseline characteristics

PTT (N=35) No PTT (N=16) P-value

Age (years)

Mean (SD) 59 (9) 56 (67) 0.27

BMI

Mean (SD) 29 (5) 29 (55) 0.83

PD duration (mo)

Mean (SD) 24 (28) 19 (15) 0.53

Duration of curve stability (mo)

Mean (SD) 14 (24) 10 (9) 0.57

Multiplanar curve

n (%) 16 (46) 6 (38) 0.58

Indentation

n (%) 13 (37) 8 (50) 0.39

Calcification

n( %) 4 (11) 4 (25) 0.38


Results: baseline characteristics

PTT (N=35) No PTT (N=16) P-value

Primary Curve in

degrees,

mean (SD)

56 (19) 51 (20) 0.41

Secondary Curve in

degrees,

mean (SD)

12 (16) 11 (14) 0.92

Composite curve in

degrees,

mean (SD)

67 (25) 62 (25) 0.49

Stretched penile length

(mm)

135 (20) 138 (22) 0.77

Traction

Hrs/day,

mean (SD)

2 (1) 0 (0) --

Hrs/wk,

mean (SD)

10 (6) 0 (0) --

Hrs total,

mean (SD)

256 (173) 0 (0) --


Results: curve improvement

PTT (+) PTT (-) P-value

Absolute improvement (deg)

Primary curve, mean (SD) 16.1 (14.9) 20.8 (15.3) 0.30

Composite curve, mean (SD) 19.6 (16.1) 23.6 (19.9) 0.45

Relative improvement (%)

Primary curve, mean (SD) 30.4 (32.5) 43 (32.6)

Composite, mean (SD) 32.6 (26.8) 27.5 (30.1)


Results: curve improvement by traction durationTraction hours per day (p=0.63) Traction hours per week (p=0.60)

Traction hours total (p=0.81)


Results: SPL (corona to pubis)

0

2

4

6

8

10

12

14

Initial SPL

Final SPL

P=0.21

13.5 13.9 13.513.8

PTT (+) PTT (-)


Results: subjective outcomes

PTT (+) PTT (-) P-value

Restoration of

penetrative intercourse

n (%)

9 (69) 4 (57) 0.80

Prevention of surgery

n (%)

16 (55) 6 (43) 0.86

Patient-reported %

improvement in curve

mean (SD)

31.4 (31.1) 42.2 (32.3) 0.42


Limitations

• Single institution

• Lack of control group

• Low adherence to recommended PTT duration

• Patient report

• Andropenis

Strengths

• Analysis of objective and subjective outcomes

• Real-life data – PTT utilization in actual clinical practice


• Actual utilization of concurrent PTT with CCH declined in both duration and frequency with subsequent CCH series

• PTT did not significantly improve the extent of penile curve improvement realized with CCH

CONCLUSIONS


• While not statistically significant, there was a trend towards increased SPL in patients who perform concurrent PTT (clinical significance is questionable)

• Further prospective, randomized research is required to determine the role for concurrent PTT with CCH

CONCLUSIONS


THANK YOU

penile traction does not improve outcomes with collagenase ...penile traction does not improve...

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