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Response to Comment on: Comparative outcomes of intralesional collagenase injection for Peyronie’s disease: acute vs. stable phase treatment

International Journal of Impotence Research (2025)Cite this article

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We thank the authors for their thoughtful commentary and for contributing to the ongoing discussion regarding the use of intralesional collagenase clostridium histolyticum (CCH) in patients with Peyronie’s disease (PD) during the acute phase [1]. We greatly appreciate their thorough analysis and insights, which align with the findings presented in our study. In summary, the authors advocate for a more individualized, patient-centered approach to the management of PD. They propose that men experiencing significant psychological distress, particularly those with severe curvature (>45°) or functional impairment, may benefit from early intervention with intralesional CCH, rather than deferring treatment until the disease reaches a stable phase. They highlight that timely treatment could help alleviate the emotional and sexual burden often associated with prolonged watchful waiting. At the same time, they suggest that patients with mild symptoms may be better suited for observation, especially given the potential for spontaneous resolution in some cases. Finally, while they view emerging data as supportive of acute-phase treatment, they stress the need for prospective, randomized trials to establish more definitive guidance and ensure optimal patient selection.

As the authors note, our data demonstrated that curvature improvement was comparable between patients treated during the acute (82.1%) and stable (76.4%) phases (p = 0.72), with no significant difference in safety profiles [2]. This supports the growing evidence that treatment during the acute phase is both safe and effective, corroborating previous findings by Hu et al. and Nguyen et al. and challenging the long-standing paradigm of deferring treatment until the disease stabilizes [3, 4].

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References

  1. la V, Pozzi E, Ramasamy R. Comment on: Comparative outcomes of intralesional collagenase injection for Peyronie's disease: acute vs stable phase treatment. Int J Impot Res. 2025. https://doi.org/10.1038/s41443-025-01156-w.

  2. Kuchakulla M, Bhambhvani HP, Wald G, Basourakos SP, Lewicki PJ, Gal J, et al. Comparative outcomes of intralesional collagenase injection for Peyronie’s disease: acute vs. stable phase treatment. Int J Impot Res. 2025 https://doi.org/10.1038/s41443-025-01055-0.

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Authors and Affiliations

  1. Department of Urology, New York-Presbyterian Hospital, New York, NY, USA

    Manish Kuchakulla, Hriday P. Bhambhvani, Gal Wald, Spyridon P. Basourakos, Patrick J. Lewicki, Jonathan Gal & James Kashanian

  2. Department of Urology, Weill Cornell Medical Center, New York, NY, USA

    Manish Kuchakulla, Hriday P. Bhambhvani, Gal Wald, Spyridon P. Basourakos, Patrick J. Lewicki, Jonathan Gal & James Kashanian

Authors
  1. Manish Kuchakulla
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  2. Hriday P. Bhambhvani
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  3. Gal Wald
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  4. Spyridon P. Basourakos
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  5. Patrick J. Lewicki
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  6. Jonathan Gal
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  7. James Kashanian
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Contributions

Conceptualization (MK, HB, GW, SB, PL, JG, JK); writing – original draft preparation (MK, HB, GW, JK); writing – review and editing (MK, HB, GW, SB, PL, JG, JK); supervision (JK). All authors have contributed substantially to this manuscript. All authors have read and agreed to the published version of this manuscript.

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Correspondence to James Kashanian.

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Kuchakulla, M., Bhambhvani, H.P., Wald, G. et al. Response to Comment on: Comparative outcomes of intralesional collagenase injection for Peyronie’s disease: acute vs. stable phase treatment. Int J Impot Res (2025). https://doi.org/10.1038/s41443-025-01138-y

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