New Drug For Peyronie’s Disease: Xiaflex

Blog #140

Peyronie’s Disease is an inflammatory condition of the penis that causes a curved penis, creating a deformed and often uncomfortable erection that can dramatically interfere with one’s sexual health. It is not uncommon, with an estimate of 65,000-120,000 cases per year in the USA with only a small fraction treated. Although it can manifest at any age, it most commonly occurs in the 50-60 year old population.

Peyronie’s disease can cause pain with erections; penile angulation; the presence of a penile scar that can be felt as a hard lump under the skin; a visual indentation of the penis described as an hour-glass deformity; and failure of the penis to properly fill with blood, causing poor erections.

The curvature can range from a very minor, barely noticeable deviation to a deformity that requires “acrobatics” to achieve vaginal penetration to an erection that is so angulated that intercourse is physically impossible.  The angulation can occur in any direction and sometimes involves more than one angle, depending on the number, location and extent of the scarring. Although the scarring is physical, it often has psychological ramifications, causing anxiety and depression.

The good news is that the FDA just approved a promising new non-surgical option for treating Peyronie’s. Xiaflex—aka collagenase—derived from the bacterium clostridium histolyticum, had previously been approved for Dupuytren’s contracture, an similar situation to Peyronie’s that occurs on the hand, causing a scarring of the tissue beneath the skin of the palm and fingers, making it very difficult to straighten one’s the fingers. This new medication functions as a “chemical knife” capable of dissolving collagen, the main constituent of scar tissue.

Xiaflex, indicated for men with an angulation of 30 degrees or more, is injected directly into the scar tissue after which the area is massaged and modeled to disrupt the scar tissue and mold the penis.  One course of treatment may involve as many as eight injections. Injection of this medication can be highly effective, but is not without side effects that may include bruising, swelling, pain and possibly rupture of the erectile cylinder of the penis causing a penile fracture.

Surgical procedures for Peyronie’s will generally result in greater improvements in the curvature than will the Xiaflex injections, but pose much greater risks of complications such as erectile dysfunction, changes in penile sensation and penile shortening.

Bottom Line: When scar tissue occurs on an area of the body that moves or expands it affects form as well as function, which can be disabling… thus, the significant impairment with Peyronie’s disease and Dupuytren’s contracture. It comes down to scar tissue in a bad place. Xiaflex is a promising new treatment, an interesting drug capable of dissolving scar tissue, obtained from the Clostridium bacteria.

Andrew Siegel, M.D.

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Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in March 2014.

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