The impact of collagenase clostridium histolyticum (CCH) priming on surgical outcomes in Peyronie's disease: a retrospective cohort study.

BACKGROUND: Peyronie's disease (PD) is a connective tissue disorder characterized by fibrous plaque formation within the tunica albuginea, resulting in penile curvature, pain, and sexual dysfunction. Although collagenase clostridium histolyticum (CCH) injections are an established nonsurgical therapy, surgical correction remains the gold standard for men with severe deformity or persistent functional impairment. The influence of prior CCH exposure ("CCH priming") on subsequent need for surgical correction and specific surgical outcomes remains incompletely understood. Our aims were to quantify the proportion of men with PD who underwent tunica albuginea plication after CCH therapy and to compare baseline characteristics and surgical outcomes between patients with and without prior CCH exposure. METHODS: We conducted a retrospective analysis of 926 men with PD under institutional review board approval. Patients were categorized by prior CCH treatment and subsequent tunica albuginea plication. Continuous variables were compared using independent t-tests, and categorical variables were analyzed with chi-square or Fisher's exact tests. Statistical significance was defined as P<0.05. Our primary outcomes included the proportion of patients undergoing plication after CCH, preoperative and postoperative curvature, in-hospital complications, 30-day and 90-day complication rates, and revision surgery rates. RESULTS: Of 926 patients, 322 received CCH therapy. Among these, 25 (7.8%) underwent subsequent plication compared with 34 (5.6%) of 604 men without prior CCH. Baseline comorbidities were similar between groups, except for a higher prevalence of testosterone replacement therapy use in the CCH cohort. Preoperative curvature did not differ significantly (56.6° vs. 51.2°, P=0.27), nor did postoperative curvature (4.6° vs. 3.0°, P=0.43). In-hospital and 90-day complication rates were comparable (P>0.05). Short-term (≤30-day) complications were numerically higher in the CCH group (20.0% vs. 2.9%, P=0.07) but were not statistically significant. Revision surgery rates were comparable between patients with prior CCH exposure (12.0% vs. 5.9%, P=0.53) and 100% of the revisions were surgical for both groups. CONCLUSIONS: Prior CCH exposure was not associated with statistically significant differences in curvature correction or complication rates following tunica albuginea plication, and revision surgery rates were also not statistically different between groups. Larger studies are warranted to improve statistical power to better evaluate potential differences in revision rates and other surgical outcomes.