Collagen Injections for Post-Penile Fracture Curvature

Assessment of Candidacy for Collagen Injections

The American Urological Association recommends that Collagenase of Clostridium histolyticum (CCH) injections may be considered for penile curvature resulting from a penile fracture that occurred 12 months ago, but only if the curvature is between 30° and 90° with a palpable plaque and the patient maintains intact erectile function 1
For patients with residual curvature after penile fracture repair, the European Association of Urology suggests treatment options depend on the degree of curvature, with CCH being FDA-approved for curvatures between 30° and 90° 1
The presence of a palpable plaque is required for CCH treatment, as indicated by the American Urological Association 1
Erectile function status is a crucial factor, with intact erectile function being a requirement for CCH consideration, according to the European Association of Urology 1
The stability of the curvature is also an essential consideration, with treatment indicated for stable disease without active pain or progressive deformity, as recommended by the European Urology guidelines 2, 3

For active disease, the European Urology guidelines recommend NSAIDs for pain management, and daily tadalafil 5 mg may help reduce curvature progression and improve symptoms 2, 3
For stable disease, CCH injections are a first-line option for curvature between 30°-90° with intact erectile function, with an average improvement of approximately 17° reduction in curvature, as reported by the American Urological Association 1
The treatment protocol for CCH involves 0.58 mg per injection into the plaque, with proper spacing between treatment cycles (6 weeks), as approved by the FDA and recommended by the European Association of Urology 1

Surgery should only be considered after disease has been stable for 3-6 months, as recommended by the European Urology guidelines 5
For patients with erectile dysfunction, penile prosthesis implantation is indicated, according to the European Association of Urology 5
For patients with preserved erectile function, tunical shortening procedures are recommended for curvatures <60°, and tunical lengthening with grafting for curvatures >60° or complex deformities, as suggested by the European Urology guidelines 4
Tunical lengthening procedures carry a significant risk of postoperative erectile dysfunction (up to 50%), as reported by the European Urology guidelines 4

CCH treatment should be administered by a urologist experienced in urological disease treatment, as recommended by the American Urological Association 1
Patients should be counseled about potential adverse events, including penile ecchymosis, swelling, pain, and rare but serious complications like corporal rupture, as indicated by the European Association of Urology 1
Alternative non-surgical options with limited evidence include penile traction therapy (PTT), extracorporeal shockwave therapy (ESWT), and vacuum erection devices (VEDs), as reported by the European Urology guidelines 6