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This article is a response to comments and questions raised by Drs. Desouky and Levine regarding a clinical trial comparing collagenase Clostridium histolyticum (CCH) to surgery for Peyronie's Disease. The authors address concerns about the study design, sample size, and surgical techniques. They argue that their study reflects current practice and that personal opinions should not override data in clinical practice. The text also discusses concerns about the proliferation of therapeutic options for localized prostate cancer and the potential financial incentives driving their uptake. The authors emphasize the importance of active surveillance and careful consideration of advancements in prostate cancer care. [Extracted from the article]

Purpose: Glans vascular compromise had previously been considered a rare but devastating complication of the subcoronal incision for inflatable penile prosthesis surgery. Here, we describe the largest series of subcoronal implants to date to assess contemporary complication rates. Materials and Methods: A retrospective review of subcoronal prosthesis placements by a single surgeon from Seoul, South Korea, was performed. Patients were randomly assigned either Coloplast Titan or AMS 700 device per institutional practice. Results: A total of 898 patients who underwent subcoronal implants from May 2015 to March 2022 were analyzed. Median follow-up was 41 months (IQR 40). Preoperative patient comorbidities included diabetes (36.6%) and Peyronie’s disease (4%). The most common complication was transient distal penile edema (74.7%). Transient incisional paresthesia (20.6%) was more common in patients with diabetes (31.9% vs 13.9%, P < .01). Five cases (0.5%) of distal penile skin necrosis were reported in patients who had previously been circumcised. Of these, 3 were managed successfully with wet-to-dry dressing, 1 required skin grafting, and 1 required device explant. Device infection without incisional compromise occurred in 2 cases (0.2%). There were no instances of glans necrosis or ischemia observed in this cohort. Of the first-time implants (817, 90.9%), most (62.3%) were successfully completed under local anesthetic alone, with the remainder of surgeries completed with the addition of adjunctive conscious sedation. Conclusions: Subcoronal incision for first-time or revision penile implant surgery is not a risk factor for glans ischemia or necrosis and can be safely completed under local anesthetic with or without conscious sedation. [ABSTRACT FROM AUTHOR]

Purpose: Priapism is a debilitating condition that affects sexual function. As a majority of cases are idiopathic, investigators have hypothesized underlying vascular dysfunction which may predispose men to priapism. We sought to determine if men are at risk for other sequelae of vascular dysfunction such as cardiovascular and thromboembolic disease after a priapism event. Materials and Methods: Using a large commercial insurance claims data warehouse, we evaluated all men (age ≤20) with a diagnosis of priapism from 2003-2020 and matched them to a cohort of men with other urological disorders of sexual dysfunction (erectile dysfunction, Peyronie's disease, and premature ejaculation). We identified incident disease (cardiovascular disease, heart disease, embolism, thrombosis, cerebrovascular disease) for all cohorts. Results: A total of 10,459 men with priapism were identified and were matched to men with erectile dysfunction, Peyronie's disease, or premature ejaculation. The mean age was 51.1 years old. Men with priapism showed increased incidence of heart disease, both ischemic (HR 1.24, 95% CI 1.09-1.42) and other heart disease (HR 1.24, 95% CI 1.12-1.38) in the years following the priapism diagnosis. Incident cerebrovascular disease was also more likely in men with a history of priapism (HR 1.33, 95% CI 1.15-1.55). Men requiring treatment for ischemic priapism had a higher hazard of cardiovascular and cerebrovascular disease. In addition, men with more priapism episodes had a higher rate of cardiovascular disease and thromboembolic events. Conclusions: Men with priapism are at increased risk for cardiovascular and cerebrovascular events in the years following a priapism. [ABSTRACT FROM AUTHOR]

The letter discusses a study comparing the effectiveness of Collagenase Clostridium histolyticum (CCH) and surgical treatment for Peyronie's Disease (PD). The study found that while CCH had advantages, surgical interventions were more effective in reducing curvature. However, surgery also had drawbacks such as increased pain and length loss. The letter highlights the limitations of the study, including a small cohort size and short follow-up period, and suggests the need for further research and long-term assessments of treatment outcomes. [Extracted from the article]

The text consists of two letters to the editor published in the Journal of Urology. The first letter discusses concerns about the proliferation of therapeutic options for localized prostate cancer and suggests focusing on minimizing side effects and achieving the best possible outcomes while also being economically viable. The letter highlights the potential benefits of active surveillance for certain patients and the use of prostate-specific membrane antigen positron emission tomography/CT to select patients for the omission of pelvic lymph node dissection. The second letter responds to critiques of a study on the 4Kscore, a model for predicting prostate biopsy outcomes, and defends the inclusion of a race coefficient in the model for more accurate risk prediction in Black men. [Extracted from the article]

The given document is a letter to the editor in response to a randomized clinical trial comparing complications following transrectal and transperineal prostate biopsy. The authors of the letter express concerns about the study's conclusion that both techniques are equally safe regarding infectious complications, as it goes against current recommendations and previous studies. They highlight factors such as the presence of fever as a bias, the difference in procedural settings, and the use of prophylactic antibiotics. The authors suggest that the sample size may be underestimated, leading to limitations in the study's results. In another letter, the authors discuss a randomized trial comparing collagenase Clostridium histolyticum (CCH) injection therapy to surgical treatment for Peyronie's disease. While CCH showed advantages, surgery demonstrated greater improvements in curvature but came with drawbacks such as increased pain and length loss. [Extracted from the article]

Purpose: The safety label for collagenase Clostridium histolyticum was updated to include postinjection acute lower back pain as an adverse event observed with intralesional therapy for Peyronie’s disease. Incidence and causality are unknown. We assessed frequencies and temporal associations for this adverse event in a large cohort. Materials and Methods: Data on all men undergoing collagenase injections for Peyronie’s disease at our institution from October 2015 through December 2020 were retrospectively assessed. The study included 330 patients, 300 completing at least 1 full course (8 injections). Measured outcomes included incidence and timing of back pain, and associations with demographics and comorbidities. Results: Of 330 patients, 19 (5.8%) experienced at least 1 episode of postinjection acute lower back pain. Of 300 who completed at least 1 full course of 8 injections, 4 (1.3%) reported back pain within the 8-injection course. A subset underwent additional rounds (16 or 24 injections). Back pain increased to 8.7% (13/149) during a second round, 6.9% (3/43) during a third. No association was found with age, diabetes or back pain history. Most cases occurred shortly after injection; all were self-limited or resolved with a single dose of ketorolac. Conclusions: This single-center, retrospective analysis suggests that intralesional collagenase injections for Peyronie’s disease may cause acute lower back pain in up to 6% of patients. Patients may benefit from counseling regarding this risk. Incidence rises with additional rounds of treatment. Prospective safety data regarding >8 injections do not exist. No patient had long-term sequelae of back pain. [ABSTRACT FROM AUTHOR]

Purpose: We describe the sealing technique with collagen fleece in patients with advanced Peyronie's disease (PD) and provide the prospective long-term outcomes. Materials and Methods: We performed a multicenter cohort study in patients with preserved erectile function and stable PD that precluded sexual intercourse. All patients underwent partial plaque excision with collagen fleece grafting. The applied technique is explained through a high-quality video accompanied by relevant animations. After hospital discharge, all patients were assessed at 1, 4 and 24 weeks after treatment. Subsequently, they presented for an additional long-term evaluation. Results: From December 2004 to June 2015, 367 patients underwent surgery. Of these, 319 (86.9%) presented for the long-term evaluation and were included in the present study. At a median operative time of 79.8 minutes (range 50e130), total straightness of the penis was achieved in 299 cases (93.7%) and mean SD penile length increased by 1.1≥0.6 cm (p[0.017). After a median followup of 47.2 months (range 12e100), 291 patients (91.2%) presented with complete penile straightness. The penile glans sensation returned to the preoperative levels in 300 cases (94%). Only 11 cases of treatment-related grade 1 Clavien-Dindo complications were reported. Erectile function improved in 78 participants (24.5%) and remained unchanged in 191 (59.8%), whereas it was worsened in 50 (15.7%). Overall, the patient satisfaction rate was 87.8% and the partner satisfaction rate was 84.3%. Conclusions: Grafting with collagen fleece in patients with advanced PD is a safe and effective procedure that reduces operative time, provides an additional hemostatic effect and represents a cost-effective technique. [ABSTRACT FROM AUTHOR]

Purpose: Since Food and Drug Administration approval of collagenase Clostridium histolyticum for Peyronie's disease, there has been significant debate regarding its role and comparable efficacy to surgery., Materials and Methods: A randomized, controlled trial was performed of Peyronie's disease men treated with either collagenase C histolyticum + RestoreX penile traction therapy + sildenafil or penile surgery + RestoreX penile traction therapy + sildenafil, with 3-month data presented. Primary objectives were overall satisfaction, subjective changes in erectile function, penile sensation, penile length, and changes in the International Index of Erectile Function-Erectile Function Domain score. Secondary outcomes included objective changes in length, curve, adverse events, and other standardized and nonstandardized questionnaires., Results: A total of 40 men were enrolled, with 38 (collagenase C histolyticum group = 19, surgery group = 19) completing treatment and having 3-month data available. All demographic and clinicopathological variables were similar between groups. Following treatment, 50% of men in the collagenase C histolyticum group reported being very satisfied (vs 21% in the surgery group, P = .08) and noted better subjective erectile function (100% vs 68%, P = .03) and penile length (88% vs 16%, P < .0001), lesser impacts on penile sensation (75% vs 11% no change, P < .001), and similar International Index of Erectile Function-Erectile Function Domain changes (+1.5 vs +2.5, P = .91). Objectively, men in the surgery group had greater curve improvements (84% vs 54%, P < .01) and higher rates of adverse events (50 vs 13 events, P < .001) but decreased penile length (-0.5 cm vs +1.0 cm, P < .01)., Conclusions: At 3 months posttreatment, collagenase C histolyticum + RestoreX penile traction therapy + sildenafil results in lesser curve improvements but greater penile length and fewer adverse events, including impacts on subjective erectile function and sensation, than men treated with surgery.