Session: MP36: Sexual Function/Dysfunction: Peyronie’s Disease
MP36-03: Response to Intralesional Collagenase Clostridium Histolyticum Therapy in Men with Peyronie’s Disease is Independent of Baseline Testosterone Levels
Introduction: Testosterone plays an important role in collagen metabolism, TGF-ß1 expression, and wound healing, all implicated in pathogenesis of Peyronie’s disease (PD). While evidence is mixed, some clinical studies have suggested an association between PD and hypogonadism. We seek to investigate whether baseline total serum testosterone (tT) influences response to intralesional collagenase clostridium histolyticum (CCh) for PD. Methods: A retrospective review of patients undergoing CCh injections was conducted at a single institution. Curvature was assessed after in-office intracavernosal injection of vasodilatory agents or patient-provided photograph. Data was collected on baseline demographic characteristics, hypogonadal status, tT, number of CCh cycles, and pre- and post-treatment degree of curvature. Hypogonadism was defined as a tT <300ng/dL, or a documented diagnosis. Results: A total of 36 men were included with a mean age was 58.2 years old (SD 10.4). The mean pre-treatment tT was 459.2 ng/dL (SD 144.0), and 14 (39.9%) were hypogonadal, of whom 5 (35.7%) were receiving hormonal replacement therapy, 4 on testosterone and 1 on clomiphene. Mean pre-treatment curvature was 47.6° (SD 14.2) and mean post-treatment curvature was 27.8° (SD 10.7), for a mean improvement of 19.9° (40.1%) after a median of 4 cycles (2-8). Hypogonadism was significantly associated with more severe curvature, 54.6° among hypogonadal men compared to 43.2° among eugonadal men (p=0.03); however, baseline curvature and tT were not significantly associated (ß=-0.03; R2=0.09; p=0.08). On linear regression analysis, tT did not significantly predict improvement in degrees (ß=-0.02; R2=0.06; p=0.14) (Figure 1) or percent (ß=0.0; R2=0.05; p=0.18). Improvement in neither degrees nor percent differed by hypogonadal status (p=0.14 and p=0.69, respectively). Number of cycles did significantly predict greater improvement in curvature on both univariate and multivariate analyses (ß=5.7; R2=0.34; p<0.01). Conclusions: While hypogonadism is associated with more severe curvature, neither total testosterone nor hypogonadism is associated with degree of improvement after CCh treatment. Men should be offered CCh therapy according to guidelines independent of gonadal status. SOURCE OF Funding: None
