Peyronie’s disease, characterized by penile curvature and deformities, can significantly impact men’s lives. Xiaflex offers a non-surgical treatment option.
Understanding Peyronie’s Disease
Peyronie’s disease involves the formation of fibrous scar tissue, known as plaque, beneath the skin of the penis. This plaque can cause the penis to bend, curve, or lose length or girth during an erection. The scar tissue interferes with the natural elasticity and stretching of penile tissues, leading to the characteristic curvature.
Beyond curvature, individuals with Peyronie’s disease may experience other symptoms, including lumps in the penis, painful erections, and sometimes erectile dysfunction. The location of the scar tissue determines the direction of the bend, which can be upward, downward, or to the side. In some instances, the scar tissue can wrap around the penis, causing an indentation that gives it an “hourglass” appearance. These physical changes can lead to difficulties with sexual intercourse and may cause emotional distress, anxiety, or impact relationships.
Xiaflex: A Targeted Treatment
Xiaflex (collagenase clostridium histolyticum) is a prescription medication approved for Peyronie’s disease. It is a biologic medicine containing enzymes that specifically target and break down collagen, a primary component of the fibrous plaque. The medication works by attaching to the plaque’s complex fibers, unwinding them, and breaking down the bonds that hold the plaque together. This helps remodel the scar tissue, reducing penile curvature. A trained healthcare professional administers the treatment directly into the plaque via injection.
Achieving Treatment Outcomes
The effectiveness of Xiaflex is measured by reduced penile curvature and improved symptoms. Clinical trials evaluated these outcomes in men with stable Peyronie’s disease and at least 30 degrees of curvature. Studies showed Xiaflex significantly reduced penile curvature compared to a placebo, with one study reporting a 17% average reduction and another an 11% average reduction. This translates to an average improvement of about 17 degrees for Xiaflex-treated patients, compared to 9 degrees in placebo groups.
Patients also reported improvements in their “bother score,” which assesses concern about appearance, pain, and impact on intercourse. A successful response is often considered when curvature is reduced to less than 15 degrees.
The Xiaflex Treatment Process
Xiaflex treatment involves a series of cycles, each lasting about six weeks, with a full course including up to four cycles. During each cycle, two Xiaflex injections are administered directly into the plaque, usually one to three days apart. Following injections, a healthcare professional performs an in-office penile modeling procedure, gently stretching and straightening the penis to further break down the plaque and reduce curvature. Patients also perform gentle at-home stretching exercises daily for about six weeks after each cycle. Sexual activity should be avoided for at least four weeks after the second injection of each treatment cycle.
Patient Suitability and Considerations
Not all individuals with Peyronie’s disease are candidates for Xiaflex. Healthcare providers consider patients with stable disease, meaning their curvature has not worsened for at least six months. The curvature must be palpable and range between 30 and 90 degrees. Patients should have adequate erectile function, with or without medication, as a straight penis is only beneficial if it can achieve sufficient hardness for sexual activity.
Xiaflex is not recommended if the plaque involves the penile urethra or has extensive calcification, as this can interfere with injection effectiveness. Patients must also be committed to the full treatment regimen, including in-office procedures and daily at-home stretching. While Xiaflex offers a non-surgical option, temporary side effects like bruising, swelling, and pain at the injection site can occur, and serious risks such as penile fracture are rare but possible.