What is Xiaflex?

What is this Xiaflex that people are talking about?

Xiaflex is the trade name for a drug called collagenase clostridium histolyticum.  

Xiaflex is a medication used to treat Peyronie’s disease which can cause penile curvature.

How do I know if I am a candidate for this Peyronie's Disease treatment?

The main indication is for patients with a Peyronie’s plaque that can be felt on exam and curvature greater than 30 degrees.  Now we live in the world of insurance and depending on your insurance, they may require failure of prior treatment before approving Xiaflex. 

What is the treatment protocol for Xiaflex?

There is a whole process that is followed for giving Xiaflex.  Xiaflex technically is the only FDA approved, non-surgical treatment for Peyronie’s disease.

You will come to the office and a medication will first be injected into the penis to create an erection.  This is to help examine the location of the curvature of the penis so that the medication can be delivered in the most precise location.  

Once the penis is not hard anymore, the Xiaflex medication will be injected into the Peyronie’s plaque.  This whole process is then repeated 2-3 days later.  

After this, 2-3 days later you will started to model the penis.

Huh, I don’t want to be a penis model. What does that have to do with anything?

No, no, no.  You aren’t going to be a penis model.  So each cycle of treatment has three parts.  Two injections and then penile modeling.  

Penile modeling has two components.  The first is stretching.  Every day, three times a day, you will stretch the penis. The second is straightening.  When you have an erection, you will bend or straighten the penis in the direction opposite to the curve.

Steps for Penile Stretching

  1. Done when penis is not erect
  2. With one hand, pinch and hold the head of your penis with your fingers. 
  3. With your other hand, hold the base of the penis in place with your fingers.  The base of the penis is the side of the penis closer to your body
  4. Gently pull the penis straight away from your body.  Count slowly to 30 seconds.
  5. Let go
xiaflex-penile-stretching

Steps for Penile Straightening

xiaflex-penile-straightening
  1. When the penis is erect
  2. With one hand, hold the base of the penis with your fingers
  3. With your other hand, take 2-3 fingers and bend the penis in the OPPOSITE direction of the curvature. 
  4. Hold this position for 30 seconds.

So now I completed one cycle, what happens next?

Well now we wait.  For the first 4 weeks after the cycle is done, you cannot have sex and I’ll explain why below.  

Additionally, you should not use a vacuum erection device or a penile traction device during this period as well.

After six weeks, we can then repeat the cycle.  The overall Xiaflex treatment can last 4 cycles.  Sadly, this is a long process but in the end it is usually worth it.  Peyronie’s disease takes time to get better and unfortunately this is a long treatment process.

Xiaflex-treatment-schedule

Wow, this is going to take some time. What benefit can I expect from treatment and do I have to do all 4 cycles?

On average, patients will see a 33% percent improvement in the curvature.  

I tell all my patients that you will usually need to do at least 2 cycles but pretty much assume that you will need all four.  Now, for those with multiple plaques, you may need 4 cycles for each plaque.  This is why we create the erection to focus on the area where the curve is most pronounced.  

All in all, it is a long treatment but technically Xiaflex is the only FDA-approved non-surgical treatment for Peyronie’s disease and can help avoid a surgery.

How will I feel after the injections?

I tell all my patients that your penis will look like its been in a bar fight and lost.  This is a treatment that you will have to earn.  

The penis will get bruised and swollen.  For that first week it will feel pretty sore.  This medicine is strong stuff.  It has to be strong enough to break down the plaque that is on your penis and giving you curvature.

What should I expect during treatment?

The week during the Xiaflex injections is pretty rough.  The penis will get swollen and/or bruised and pretty sore.  After that it gets much better.  For some people, the bruising can be pretty substantial and can spread down into the scrotum and near the pubic hair region.

For some patients, I will notice “blood blisters”. Usually the skin will get very thin near this blood blister and it will pop.  If you notice this, I will usually recommend placing Vaseline on this area for comfort until it heals up.  Sometimes you will even need to wrap the penis in gauze.

The biggest risk that we worry about during treatment is a “penile fracture” or corporal rupture.  This is where the lining of the penis where the erection forms has a tear.  This is why we tell our patients to avoid sex for a month after the injection.  Even for those who stay abstinent, it can happen spontaneously.  Sometimes this can heal without any surgery but other times we will need to urgently take a patient to the operating room to fix the site of the rupture.

What are other potential side effects?

  • Corporal rupture aka penile fracture.  This is why you aren’t allowed to have sex for the first four weeks after the injections.  This is the most serious and thankfully a very rare side effect that may require surgery to fix
  • Bruising and even a collection of blood along the penis, scrotum and pubic hair region
  • Penile pain
  • A hard lump or knot at the site of the injection
  • Erectile dysfunction

Any good resources to review?

Here is a link to the brochure the company provides https://peyronies-disease.xiaflex.com/dist/pdf/hcp/xiaflex-patient-roadmap.pdf.  This is also the source for the images above.   Additionally, the American Urologic Association has published guidelines at https://www.auanet.org/guidelines/peyronies-disease-guideline

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