{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T17:05:14Z","timestamp":1758819914615},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2021,5,18]],"date-time":"2021-05-18T00:00:00Z","timestamp":1621296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2021,5,18]],"date-time":"2021-05-18T00:00:00Z","timestamp":1621296000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["jsm.jsexmed.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,6,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>It is currently unclear if men with Peyronie\u2019s Disease (PD) who achieve minimal benefits with the first 2 series of Collagenase Clostridium Histolyticum (CCH) injections should continue with additional injections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To analyze curvature improvements from the final two series of CCH injections based on amount of improvement during the first 2 series.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospective registry was analyzed of all men undergoing CCH injections for PD at a single institution. Men were included if they had completed a full 4 series (8 injections) of CCH and had baseline, interval (after 2 series), and\/or final (after 4 series) curvature assessments available. Men were stratified into cohorts using baseline-to-interval assessments of \u226410\u00b0 (or \u226420%) and &amp;gt;10\u00b0 (or &amp;gt;20%), and improvements were compared using interval-to-final assessments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes<\/jats:title><jats:p>The primary outcome was interval-to-final curvature improvements stratified by \u226410\u00b0\/&amp;gt;10\u00b0 or \u226420%\/&amp;gt;20% improvements achieved during the baseline-to-interval period. Secondary outcomes included analyses of demographic and pathophysiologic variables to determine associations with significant improvements during the final 2 CCH series.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>A total of 296 PD men were identified as receiving at least one CCH injection, of whom 175 had baseline-to-interval, 84 interval-to-final, and 115 with baseline-to-final measurements. Mean age was 56.6, PD duration 28.6 months, baseline curvature 63.4\u00b0, hourglass deformity 36.2%, and calcification 20%. Mean overall curve improvement was \u221221.5\u00b0 (33.1%). Among men who experienced \u226420% improvements after 2 series, the mean subsequent curvature change was -24.6% during the final two series (vs +4.3% of those with &amp;gt;20% initial improvement, P&amp;lt; .001), and they were 2.7x more likely to experience &amp;gt;20% subsequent curve improvements. Thirty-one percent of those who achieved &amp;gt;10\u00b0 during the first 2 series experienced benefits during the final 2 series compared to 70% of men who had \u226410\u00b0 improvement initially. No demographic or pathophysiological variables predicted likelihood for improvements during the final 2 series of injections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Implications<\/jats:title><jats:p>Men who fail to achieve significant benefits with 2 series of CCH injections may benefit from completing the final 2 series.<\/jats:p><\/jats:sec><jats:sec><jats:title>Strengths and Limitations<\/jats:title><jats:p>Strengths including a relatively large, prospective series. Limitations include a single center, nonrandomization, nonblinded assessments, and restriction to men who completed eight injections.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>In the current series, approximately 2\/3 of men who fail to achieve &amp;gt;10\u00b0 or 20% curve improvements with an initial 2 series of CCH injections achieved &amp;gt;10\u00b0 or 20% improvements with the subsequent 2 series.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.jsxm.2021.03.075","type":"journal-article","created":{"date-parts":[[2021,5,19]],"date-time":"2021-05-19T05:01:38Z","timestamp":1621400498000},"page":"1092-1098","update-policy":"http:\/\/dx.doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":5,"title":["Continuing Collagenase Clostridium Histolyticum Injections Among Initial Nonresponders Results in Significant Curvature Improvements in the Majority of Peyronie\u2019s Disease Men"],"prefix":"10.1093","volume":"18","author":[{"given":"Manaf","family":"Alom","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holli","family":"Burgon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Ziegelmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"K\u00f6hler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sevann","family":"Helo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Landon","family":"Trost","sequence":"additional","affiliation":[{"name":"Male Fertility and Peyronie\u2019s Clinic , Orem, UT , United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,5,18]]},"reference":[{"key":"2023041407023129300_","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1016\/S0022-5347(17)37988-0","article-title":"The incidence of peyronie\u2019s disease in rochester, minnesota, 1950 through 1984","volume":"146","author":"Lindsay","year":"1991","journal-title":"J Urol"},{"key":"2023041407023129300_","doi-asserted-by":"crossref","DOI":"10.1155\/2011\/282503","article-title":"A population-based study of peyronie\u2019s disease: prevalence and treatment patterns in the United States","volume":"2011","author":"Dibenedetti","year":"2011","journal-title":"Adv Urol"},{"key":"2023041407023129300_","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1046\/j.1464-4096.2001.02436.x","article-title":"The prevalence of Peyronie\u2019s disease: results of a large survey","volume":"88","author":"Schwarzer","year":"2001","journal-title":"BJU Int"},{"key":"2023041407023129300_","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1038\/sj.ijir.3900727","article-title":"Prevalence of Peyronie\u2019s disease in men over 50-y-old from Southern Brazil","volume":"13","author":"Rhoden","year":"2001","journal-title":"Int J Impot Res"},{"key":"2023041407023129300_","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1159\/000049830","article-title":"Peyronie\u2019s disease: prevalence and association with cigarette smoking. 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