Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
Sex Med Rev. 2018 Jan;6(1):143-156. doi: 10.1016/j.sxmr.2017.03.005. Epub 2017 Apr 25.
Peyronie's disease (PD) is a connective tissue disorder resulting in the abnormal accumulation of type I to III collagen, fibrin, and disorganized elastic fibers in the tunica albuginea of the penis. Many medical and non-pharmacologic modalities have been used in the treatment of PD; however, these approaches have proved largely ineffective, with surgery being the only definitive treatment. Intralesional injection of collagenase Clostridium histolyticum (CCH) has recently become the gold standard for minimally invasive treatment of PD, and studies have suggested the role of CCH could expand to the treatment of other urologic conditions such as urethral stricture disease.
To provide an update on available data on the use of CCH in the treatment of PD and other urologic conditions.
Comprehensive review of recent clinical trials and in vivo studies that examined the safety and efficacy of CCH in urologic disease.
Assessing the efficacy of CCH in the management of PD as determined by improvement in the severity of penile fibrosis, curvature deformity, and pain.
Several well-designed clinical trials have demonstrated the efficacy and tolerability of CCH in the treatment of PD. CCH has demonstrated significant decreases in penile curvature and plaque consistency and improvements in patient satisfaction. Treatment durability and long-term adverse effects are still being assessed; however, outcomes of PD management with CCH continue to replicate the results obtained during the IMPRESS clinical trials. Preliminary studies support the premise that CCH can modify disease progression in patients with acute-phase PD. Furthermore, one in vivo study showed that CCH also could be applied to urethral stricture disease without serious adverse complications.
CCH continues to be the mainstay for non-surgical management of stable-phase PD. However, its role in the treatment of acute-phase PD, PD with ventral plaques, and urethral stricture disease could expand in the coming years. Gabrielson AT, Spitz JT, Hellstrom WJG. Collagenase Clostridium Histolyticum in the Treatment of Urologic Disease: Current and Future Impact. Sex Med Rev 2018;6:143-156.
佩罗尼氏病（PD）是一种结缔组织疾病，导致阴茎白膜中的 I 型至 III 型胶原、纤维蛋白和无序弹性纤维异常积聚。已经使用了许多医学和非药物方法来治疗 PD；然而，这些方法在很大程度上被证明是无效的，手术是唯一的确定性治疗方法。胶原酶 Clostridium histolyticum（CCH）的腔内注射最近已成为 PD 微创治疗的金标准，并且研究表明 CCH 的作用可能扩展到治疗其他泌尿科疾病，如尿道狭窄疾病。
提供有关 CCH 在治疗 PD 和其他泌尿科疾病中的应用的最新数据。
对最近检查 CCH 在泌尿科疾病中的安全性和疗效的临床试验和体内研究进行全面综述。
评估 CCH 在管理 PD 中的疗效，方法是改善阴茎纤维化、弯曲畸形和疼痛的严重程度。
几项精心设计的临床试验表明 CCH 在治疗 PD 中的疗效和耐受性。CCH 已显示出在阴茎弯曲和斑块一致性方面的显著降低，并改善了患者的满意度。治疗的持久性和长期不良反应仍在评估中；然而，CCH 治疗 PD 的结果仍在复制 IMPRESS 临床试验的结果。初步研究支持 CCH 可以改变急性 PD 患者疾病进展的前提。此外，一项体内研究表明，CCH 也可以应用于尿道狭窄疾病，而不会出现严重的不良并发症。
CCH 仍然是稳定期 PD 非手术治疗的主要方法。然而，在未来几年，它在治疗急性 PD、腹侧斑块 PD 和尿道狭窄疾病方面的作用可能会扩大。
