Editorial Comment: Risk Factors for Penile Fracture After Intralesional Collagenase Clostridium histolyticum in Peyronie's Disease

Favorito, Luciano A.

doi:10.1590/S1677-5538.IBJU.2024.9906

Isaac Zucker ¹ 1 Department of Urology, University of Toledo, Toledo, OH; , Sirpi Nackeeran ² 2 Department of Urology, University of California San Diego, San Diego, CA; , Sahaam Mirza ³ 3 Kansas City University, Kansas City, MO; , Thomas A Masterson ⁴ 4 Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL

Urology. 2024 Jan:183:117-120.

DOI: 10.1016/j.urology.2023.10.019 | ACCESS: 37949243

COMMENT

The treatment of Peyronie's disease (PD) is challenging. The paper of Zucker et al. (¹1 Zucker I, Nackeeran S, Mirza S, Masterson TA. Risk Factors for Penile Fracture After Intralesional Collagenase Clostridium histolyticum in Peyronie's Disease. Urology. 2024;183:117-20.) shows an important complication after the use of Intralesional Collagenase Clostridium histolyticum (CCh) in PD: Penile fracture. Sexual intercourse represented the main cause of PF in USA, Europe and Brazil because intercourse is generally associated with high-energy traumas (²2 Barros R, Schulze L, Ornellas AA, Koifman L, Favorito LA. Relationship between sexual position and severity of penile fracture. Int J Impot Res. 2017;29:207-9.). Recent papers showed that, the positions with the “man on top” and “doggy style” were considered the most severe, presenting greater association with urethral and bilateral lesions of the corpora cavernosa (²2 Barros R, Schulze L, Ornellas AA, Koifman L, Favorito LA. Relationship between sexual position and severity of penile fracture. Int J Impot Res. 2017;29:207-9., ³3 Syarif S, Azis A, Natsir AS, Putra MZDA. What is the most dangerous sexual position that caused the penile fracture? A systematic review and meta-analysis. Int Braz J Urol. 2024;50:28-36.).

In the present paper the authors studied retrospectively 1541 patients that received at least one injection of CCh for PD. Of them, 0.7% (11/1541) suffered corporal rupture occurred at a median of 8 days after CCh injection. The majority of fractures were secondary to spontaneous erections or sexual intercourse. Finally, six patients had their fracture repaired surgically while the remaining were managed conservatively. The authors concluded that intralesional CCh can lead to corporal rupture and the most fractures occurred within 2 weeks of CCh injections and were associated with sexual intercourse and spontaneous morning erections.

REFERENCES

¹
Zucker I, Nackeeran S, Mirza S, Masterson TA. Risk Factors for Penile Fracture After Intralesional Collagenase Clostridium histolyticum in Peyronie's Disease. Urology. 2024;183:117-20.
²
Barros R, Schulze L, Ornellas AA, Koifman L, Favorito LA. Relationship between sexual position and severity of penile fracture. Int J Impot Res. 2017;29:207-9.
³
Syarif S, Azis A, Natsir AS, Putra MZDA. What is the most dangerous sexual position that caused the penile fracture? A systematic review and meta-analysis. Int Braz J Urol. 2024;50:28-36.

Publication Dates

Publication in this collection
05 Apr 2024
Date of issue
Mar-Apr 2024

History

Received
05 Jan 2024
Accepted
25 Jan 2024
Published
31 Jan 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ¹
Zucker I, Nackeeran S, Mirza S, Masterson TA. Risk Factors for Penile Fracture After Intralesional Collagenase Clostridium histolyticum in Peyronie's Disease. Urology. 2024;183:117-20.

[2] ²
Barros R, Schulze L, Ornellas AA, Koifman L, Favorito LA. Relationship between sexual position and severity of penile fracture. Int J Impot Res. 2017;29:207-9.

[3] ³
Syarif S, Azis A, Natsir AS, Putra MZDA. What is the most dangerous sexual position that caused the penile fracture? A systematic review and meta-analysis. Int Braz J Urol. 2024;50:28-36.

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