病灶内注射溶组织梭状芽孢杆菌胶原酶治疗佩罗尼氏病及相关联合疗法的综述（更新版）

Review of Intralesional Collagenase Clostridium Histolyticum Injection Therapy and Related Combination Therapies in the Treatment of Peyronie's Disease (an Update).

作者信息

Natale Caleb, McLellan David M, Yousif Ayad, Hellstrom Wayne J G

机构信息

Department of Urology, Tulane University School of Medicine, New Orleans, USA.

出版信息

Sex Med Rev. 2021 Apr;9(2):340-349. doi: 10.1016/j.sxmr.2020.01.005. Epub 2020 Mar 18.

DOI:10.1016/j.sxmr.2020.01.005

PMID:32199788

Abstract

INTRODUCTION

Collagenase Clostridium histolyticum (CCH) is an injectable agent used to treat Peyronie's disease (PD) by enzymatically degrading the interstitial collagen in plaques. CCH has been administered via multiple treatment protocols, in combination therapies, to patients with varying curvatures and in both the acute and stable phases of this condition.

OBJECTIVES

To review the current literature and provide an update on CCH as an injectable therapy for PD, as a singular therapy or in conjunction with combination therapies, and its associated complications. We provide a brief background of PD treatments, evaluate CCH efficacy in penile curvature reduction and subjective improvement in a variety of protocols, and compare combination therapies (penile traction, sildenafil), plaque location, and efficacy in both acute and stable diseases.

METHODS

We performed a systematic review of the existing PubMed literature pertaining to CCH injection therapy in the treatment of PD and compared the effectiveness to different treatment modalities.

RESULTS

CCH is a safe and effective injectable agent for all curvature directions in both acute and stable PD. It can be used in conjunction with multiple penile modeling techniques, in combination with sildenafil, and following a shortened administration protocol. Moderate to severe treatment-related adverse events occur at a rate of 9% and are typically managed conservatively.

CONCLUSION

Intralesional injections of CCH are FDA approved as a nonsurgical treatment for men with PD. The IMPRESS trials were instrumental in demonstrating the efficacy and safety of CCH and provided a standard protocol for administration. Additional studies are required to optimize treatment protocols and use in combination therapies. Further investigation of patients with ventral curvatures, hourglass deformities, and those in acute phase is needed. Natale C, McLellan D, Yousif A, et al. Review of Intralesional Collagenase Clostridium Histolyticum Injection Therapy and Related Combination Therapies in the Treatment of Peyronie's Disease (an Update). Sex Med 2021;9:340-349.

摘要

引言

溶组织梭状芽孢杆菌胶原酶（CCH）是一种可注射药物，通过酶解斑块中的间质胶原用于治疗佩罗尼氏病（PD）。CCH已通过多种治疗方案、联合疗法用于不同弯曲程度的患者，以及该病的急性期和稳定期患者。

目的

回顾当前文献，提供CCH作为PD注射治疗的最新信息，无论是单一疗法还是联合疗法，以及其相关并发症。我们简要介绍PD治疗的背景，评估CCH在各种方案中减少阴茎弯曲和主观改善方面的疗效，并比较联合疗法（阴茎牵引、西地那非）、斑块位置以及在急性期和稳定期疾病中的疗效。

方法

我们对现有PubMed文献进行了系统回顾，这些文献涉及CCH注射疗法治疗PD，并将其有效性与不同治疗方式进行比较。

结果

CCH是一种安全有效的可注射药物，适用于急性和稳定期PD的所有弯曲方向。它可与多种阴茎塑形技术联合使用，与西地那非联合使用，并可采用缩短给药方案。中度至重度治疗相关不良事件发生率为9%，通常采用保守治疗。

结论

病灶内注射CCH已获美国食品药品监督管理局（FDA）批准，作为PD男性患者的非手术治疗方法。IMPRESS试验有助于证明CCH的疗效和安全性，并提供了给药标准方案。需要进一步研究以优化治疗方案并用于联合疗法。需要对腹侧弯曲、沙漏畸形患者以及急性期患者进行进一步研究。纳塔莱C、麦克莱伦D、优素福A等。溶组织梭状芽孢杆菌胶原酶病灶内注射疗法及相关联合疗法治疗佩罗尼氏病的综述（更新）。性医学2021；9：340 - 349。