Summary of “Improved Peyronie’s Disease Curvature Outcomes Using a Novel Collagenase Administration Protocol”

Collagenase Clostridium Histolyticum (CCH) can be used on men with Peyronie’s Disease (PD) to improve penile curvature. Since the release of CCH in 2014 studies have consistently shown penile curvature improvements in men with PD in the 14-23˚ range (similar to findings from the original IMPRESS study). Over the past several years, we have sought to improve upon outcomes through multiple modifications to the original IMPRESS technique. 

Among other changes, improvements in technique included several notable modifications:

  • The dosing / dilution of CCH
  • The spacing and number of distinct injection sites
  • Modified injection technique in cases of calcified plaques
  • Creation of an erection with the first injection of each series
  • Injection into the point of max curvature
  • Use of Restorex traction beginning soon after each injection
  • Back-to-back injection days
  • Penile numbing with in-office modeling
  • Combined use of PDE5s during the post-injection phase
  • Use of aggressive post-injection wrapping protocols to limit bruising, hematomas, and other complications.

In addition to the above changes, we also noticed that men who experienced a “pop” during erection followed by detumescence and ecchymoses (suspected fracture) ended up having greater curve improvements than those who did not experience a snap or pop sensation. This led to a change in our understanding of the treatment process of CCH and contributed to some of the above modifications. 

Overall, our study sought to compare men with PD who underwent CCH injections prior to implementation of the above protocol modifications and following.  The study included a total of 509 men using CCH from March 2015 to December 31, 2019 (pre or partial implementation of new technique) to men given the complete new treatment beginning after January 1, 2020. Results showed men using the new protocol had greater improvements in curvature using both conservative and liberal definitions for curve improvement.  Specifically, men treated with the new protocol experienced an overall 34˚ vs 20˚ or 58% vs 30% curve improvement compared to the more traditional protocol. More men using the novel technique also felt the protocol helped them prevent surgery (53% vs 18%) and restored or made it easier to penetrate (57% vs 21%). Even though there were more hematomas with the new technique, the patients’ penile sensitivity and erectile function improved at a higher rate than those not using the new technique (56% vs 26%). Importantly, the new technique did not result in a greater risk when it came to important outcome measures such as length, sensation, and erectile function.

In summary, the results from this study show nearly twice the reduction in curvature compared to other studies and represent the largest overall improvements with CCH published to date.


1. Flores, A., Tyler, A., Green, B., Price, T., Savage, J., Brearton, K., Helo, S., Ziegelmann, M., Kohler, T., and Trost, L. (2022). Improved Peyronie’s Disease Curvature Outcomes Using a Novel Collagenase Administration Protocol. Urology, 170:117-123. DOI: 10.1016/j.urology.2022.09.017

2. Cocci, A., Cito, G., Urzì, D., Minervini, A., Di Maida, F., Sessa, F., Mari, A., Campi, R., Falcone, M., Capece, M., Morelli, G., Cacciamani, G., Rizzo, M., Polito, C., Giammusso, B., Morgia, G., Verze, P., Salonia, A., Cai, T., Mirone, V., Mondaini, N., and Russo, G. (2018). Sildenafil 25 mg ODT + Collagenase Clostridium hystoliticum vs Collagenase Clostridium hystoliticum Alone for the Management of Peyronie’s Disease: A Matched-Pair Comparison Analysis. J Sex Med, 15(10): 1472-1477. DOI: 10.1016/j.jsxm.2018.08.012

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