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World J Urol. 2019 May 23. doi: 10.1007/s00345-019-02817-4. [Epub ahead of print]

Managing complications of collagenase Clostridium histolyticum (CCH) injection.

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Department of Urology, University of California San Diego, 200 W Arbor Dr # 8220, La Jolla, San Diego, CA, 92103, USA.
Department of Urology, University of California San Diego, 200 W Arbor Dr # 8220, La Jolla, San Diego, CA, 92103, USA.



The introduction of collagenase Clostridium histolyticum (CCH) has revolutionized the treatment of Peyronie's disease. The efficacy of this therapy has been well demonstrated and the safety profile is favorable. However, post-injection complications are poorly characterized and management of these complications lacks standardization.


This review includes literature published in English and indexed in the PubMed®, Embase® or Google Scholar™ databases. What follows is a synopsis of relevant articles, including original research studies, in an attempt to better define CCH complications and their respective management strategies.


Adverse effects of therapy are common but generally self-limiting. Penile pain and edema are expected events, and most patients experience hematologic sequelae (bleeding, hematoma, ecchymosis, etc.). The intervention rate for penile hematoma is low. Penile fracture is a morbid complication of therapy that is rare and may be challenging to diagnose given the frequency with which pronounced bruising and swelling are encountered. Imaging is a useful adjunct in situations of diagnostic uncertainty. Alternative injection protocols have been evaluated to limit the cost and morbidity of CCH therapy. Clinical efficacy of these protocols is promising, but prospective evaluation is lacking.


No standardized protocols exist for management of post-injection complications of CCH therapy. The majority of these complications are managed conservatively, but suspected penile fracture should be carefully evaluated and imaging employed when needed. Future prospective studies of alternative injection protocols are warranted to decrease morbidity while maintaining efficacy.


Collagenase Clostridium histolyticum; Complications; Penile fracture; Peyronie’s disease; Xiaflex


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