Introduction: Peyronie’s Disease (PD) is a common acquired disorder defined by an accumulation of fibrous tissue along the tunica albuginea resulting in a curvature of the penis. This deformity can lead to erectile dysfunction, psychological distress, and pain. Clinical management involves intralesional injection of collagenase clostridium histolyticum (CCH). While efficacious, many cases are refractory, requiring a plication procedure. We seek to investigate predictive factors for plication after receiving a CCH injection. Methods: A retrospective medical record review was performed on patients who have been treated for PD at an academic institution. Two cohorts were created, those who achieved resolution with initial CCH injection (CCH cohort) and those who failed initial CCH injection and required a plication (plication cohort). Univariate logistic regression modeling was performed to determine statistical significance. Results: A total of 282 patients were included in the study, 11% (n = 30) required CCH and a plication while 89% (n = 252) had resolution of PD with CCH injection. The median (IQR) ages in the plication and CCH cohorts were 56.7 (50.6 – 63.2) and 57.9 (52.7 – 62.9) years old, respectively. The plication cohort’s median (IQR) degree of initial curvature, (65° [45 - 90]), was significantly greater than the CCH cohort, (45° [40 - 60]); P < 0.001. Additionally, in the plication and CCH cohorts, median (IQR) testosterone levels were 343 (230 - 629) compared to 352 ng/dl (255 – 489); P = 0.07, hypogonadism was 50% (n = 15) compared to 20% (n = 51); P = 0.70, and median (IQR) plaque size was 8 (1.0 – 14.3) compared to 5.3 mm (1.4 – 9.9); P = 0.61, respectively. Median (IQR) time to CCH treatment were 3.5 (2 – 5) and 4 (2 – 9) months in the plication and CCH cohorts, respectively; P = 0.15. In the plication cohort, time to plication had a median (IQR) of 12 (8 – 20) months. Conclusions: Our analysis shows presenting degree of curvature significantly influences the probability of requiring a plication following CCH injection. Additionally, other factors such as hypogonadism, lower levels of testosterone, and larger plaque sizes may point towards trends that could predict progression to plication. These findings could be used to determine when plication should be used over CCH as initial treatment for PD. The effect would conclude in shorter waiting times for resolution of PD. SOURCE OF Funding: None
