Khooblall Prajit, Bole Raevti, Lundy Scott D, Bajic Petar
Cleveland Clinic, Center for Men's Health, Glickman Urological and Kidney Institute, Cleveland, OH, USA.
Res Rep Urol. 2023 Jun 21;15:205-216. doi: 10.2147/RRU.S386340. eCollection 2023.
In this narrative review we explore additional indications for which intralesional collagenase (CCH) injection therapy may be used, in addition to those utilized in the IMPRESS trials. The goal is to provide updated assessment of available intralesional therapies and justify whether to expand clinical indications based on advancements over the last decade.
Patients receiving CCH in the acute phase of PD have shown significant improvement in penile curvature - which may be even more significant than reported due to progressive curvature over the longitudinal course of injection therapy. Across studies, patients with ventral plaques achieved the greatest curvature improvement (~30°) compared to PD patients with dorsal or lateral plaques. Patients with curvature > 90° have been minimally documented. However, the concept of patients with higher degree of curvature achieving more significant degrees of improvement prevails across studies. Studies including PD patients with volume loss deformities or indentation(s) focus on curvature improvement and do not gauge improvement in these girth loss or indentation features specifically. PD patients with calcification may benefit from CCH, however, critical analysis of included study designs and results compared to placebo do not lend for strong support of CCH in PD at this time.
Based on the most recent research, the use of CCH in the acute phase of PD and patients with ventral penile plaques may be effective and safe. The limited available research on the efficacy of CCH on calcified plaque(s) and curvature greater than 90° is promising, however, more research is needed to ensure safety and success in this patient cohort. Finally, the current literature continues to show the use of CCH is not effective in PD patients with volume loss, indentation, or hourglass deformity. When expanding the use of CCH to patients not originally included in the IMPRESS trials, providers must prioritize minimizing chances of potential injury to urethral tissue. Finally, further investigation is required to determine whether CCH has utility for curvature greater than 90° or calcified plaques, although the limited available literature is promising.
在本叙述性综述中，我们探讨了病灶内注射胶原酶（CCH）疗法除用于IMPRESS试验外的其他可能适应证。目的是对现有的病灶内治疗方法进行更新评估，并根据过去十年的进展判断是否应扩大临床适应证。
在佩罗尼氏病（PD）急性期接受CCH治疗的患者阴茎弯曲度有显著改善，由于注射治疗过程中弯曲度会逐渐加重，实际改善程度可能比报告的更为显著。在各项研究中，与有背侧或外侧斑块的PD患者相比，有腹侧斑块的患者弯曲度改善最大（约30°）。弯曲度>90°的患者记录极少。然而，在各项研究中普遍存在弯曲度越高改善越显著的观念。纳入有体积缩小畸形或凹陷的PD患者的研究主要关注弯曲度改善情况，未具体评估这些周长缩小或凹陷特征的改善情况。有钙化的PD患者可能从CCH治疗中获益，然而，对纳入的研究设计和与安慰剂对照的结果进行批判性分析后，目前尚无法有力支持CCH用于治疗PD。
基于最新研究，在PD急性期及有腹侧阴茎斑块的患者中使用CCH可能有效且安全。关于CCH对钙化斑块及大于90°弯曲度疗效的现有研究有限，但前景良好，不过仍需更多研究以确保该患者群体的安全性和治疗成功率。最后，当前文献继续表明CCH对有体积缩小、凹陷或沙漏样畸形的PD患者无效。当将CCH的使用扩展至最初未纳入IMPRESS试验的患者时，医疗人员必须优先将尿道组织潜在损伤的可能性降至最低。最后，尽管现有文献有限但前景良好，仍需进一步研究以确定CCH对大于90°弯曲度或钙化斑块是否有效。
