PDF(Pubmed)
Abstract：
UNASSIGNED: In this narrative review we explore additional indications for which intralesional collagenase Clostridium histolyticum (CCH) injection therapy may be used, in addition to those utilized in the IMPRESS trials. The goal is to provide updated assessment of available intralesional therapies and justify whether to expand clinical indications based on advancements over the last decade.
UNASSIGNED: Patients receiving CCH in the acute phase of PD have shown significant improvement in penile curvature - which may be even more significant than reported due to progressive curvature over the longitudinal course of injection therapy. Across studies, patients with ventral plaques achieved the greatest curvature improvement (~30°) compared to PD patients with dorsal or lateral plaques. Patients with curvature > 90° have been minimally documented. However, the concept of patients with higher degree of curvature achieving more significant degrees of improvement prevails across studies. Studies including PD patients with volume loss deformities or indentation(s) focus on curvature improvement and do not gauge improvement in these girth loss or indentation features specifically. PD patients with calcification may benefit from CCH, however, critical analysis of included study designs and results compared to placebo do not lend for strong support of CCH in PD at this time.
UNASSIGNED: Based on the most recent research, the use of CCH in the acute phase of PD and patients with ventral penile plaques may be effective and safe. The limited available research on the efficacy of CCH on calcified plaque(s) and curvature greater than 90° is promising, however, more research is needed to ensure safety and success in this patient cohort. Finally, the current literature continues to show the use of CCH is not effective in PD patients with volume loss, indentation, or hourglass deformity. When expanding the use of CCH to patients not originally included in the IMPRESS trials, providers must prioritize minimizing chances of potential injury to urethral tissue. Finally, further investigation is required to determine whether CCH has utility for curvature greater than 90° or calcified plaques, although the limited available literature is promising.
UNASSIGNED: Patients receiving CCH in the acute phase of PD have shown significant improvement in penile curvature - which may be even more significant than reported due to progressive curvature over the longitudinal course of injection therapy. Across studies, patients with ventral plaques achieved the greatest curvature improvement (~30°) compared to PD patients with dorsal or lateral plaques. Patients with curvature > 90° have been minimally documented. However, the concept of patients with higher degree of curvature achieving more significant degrees of improvement prevails across studies. Studies including PD patients with volume loss deformities or indentation(s) focus on curvature improvement and do not gauge improvement in these girth loss or indentation features specifically. PD patients with calcification may benefit from CCH, however, critical analysis of included study designs and results compared to placebo do not lend for strong support of CCH in PD at this time.
UNASSIGNED: Based on the most recent research, the use of CCH in the acute phase of PD and patients with ventral penile plaques may be effective and safe. The limited available research on the efficacy of CCH on calcified plaque(s) and curvature greater than 90° is promising, however, more research is needed to ensure safety and success in this patient cohort. Finally, the current literature continues to show the use of CCH is not effective in PD patients with volume loss, indentation, or hourglass deformity. When expanding the use of CCH to patients not originally included in the IMPRESS trials, providers must prioritize minimizing chances of potential injury to urethral tissue. Finally, further investigation is required to determine whether CCH has utility for curvature greater than 90° or calcified plaques, although the limited available literature is promising.
摘要：
■在这篇叙述性综述中，我们探讨了可以使用病变内胶原酶溶组织梭菌（CCH）注射治疗的其他适应症，除了在IMPRESS试验中使用的那些。目标是提供可用的病灶内治疗的最新评估，并根据过去十年的进展证明是否扩大临床适应症。
■在PD急性期接受CCH的患者显示出阴茎弯曲的显着改善-由于在纵向注射治疗过程中逐渐弯曲，这可能比报告的更重要。在整个研究中，与有背侧或外侧斑块的PD患者相比，有腹侧斑块的患者获得了最大的曲率改善（〜30°）。曲率>90°的患者已被最低限度地记录。然而,在所有研究中,患者弯曲度越高,患者的改善程度越显著.包括具有体积损失畸形或压痕的PD患者的研究集中于曲率改善,并且不具体地测量这些围长损失或压痕特征的改善。PD患者钙化可能受益于CCH，然而,纳入的研究设计和结果与安慰剂相比的批判性分析目前并不支持CCH在PD中的应用。
■根据最新的研究，在PD和腹侧阴茎斑块患者的急性期使用CCH可能是有效和安全的。关于CCH对钙化斑块和曲率大于90°的疗效的有限的可用研究是有希望的，然而,需要更多的研究来确保该患者队列的安全性和成功率.最后,目前的文献继续表明，CCH的使用对容量减少的PD患者无效，缩进,或者沙漏畸形。当将CCH的使用扩展到最初未包括在IMPRESS试验中的患者时，提供者必须优先考虑最大程度地减少对尿道组织的潜在伤害。最后,需要进一步调查以确定CCH是否对曲率大于90°或钙化斑块具有实用性，尽管有限的可用文献是有希望的。
■在PD急性期接受CCH的患者显示出阴茎弯曲的显着改善-由于在纵向注射治疗过程中逐渐弯曲，这可能比报告的更重要。在整个研究中，与有背侧或外侧斑块的PD患者相比，有腹侧斑块的患者获得了最大的曲率改善（〜30°）。曲率>90°的患者已被最低限度地记录。然而,在所有研究中,患者弯曲度越高,患者的改善程度越显著.包括具有体积损失畸形或压痕的PD患者的研究集中于曲率改善,并且不具体地测量这些围长损失或压痕特征的改善。PD患者钙化可能受益于CCH，然而,纳入的研究设计和结果与安慰剂相比的批判性分析目前并不支持CCH在PD中的应用。
■根据最新的研究，在PD和腹侧阴茎斑块患者的急性期使用CCH可能是有效和安全的。关于CCH对钙化斑块和曲率大于90°的疗效的有限的可用研究是有希望的，然而,需要更多的研究来确保该患者队列的安全性和成功率.最后,目前的文献继续表明，CCH的使用对容量减少的PD患者无效，缩进,或者沙漏畸形。当将CCH的使用扩展到最初未包括在IMPRESS试验中的患者时，提供者必须优先考虑最大程度地减少对尿道组织的潜在伤害。最后,需要进一步调查以确定CCH是否对曲率大于90°或钙化斑块具有实用性，尽管有限的可用文献是有希望的。
