—Dr. Trost Commentary and Key Take-home Points—
The current manuscript evaluates the efficacy of Xiaflex in improving curvature in men with less common deformities, including those with downward curvatures, hourglass deformity, or decreased penile length. Not surprisingly, results showed that the therapy is indeed able to improve curvature in these conditions as well. In our own experience, we have previously published showing the Xiaflex actually works better on curves that are down or to the side and that the presence of hourglass does not impact outcomes. However, in my experience, most men with hourglass are more interested in fixing the hourglass itself rather than the specific curvature. And, unfortunately, Xiaflex is not able to fix the indentations that cause hourglass deformity. Indeed, there are not many good therapies available to fully repair hourglass deformities, and although some treatments may help mildly (e.g. traction), the best therapies to improve hourglass (surgery) often have significant side effects that can be worse than the treatment (erectile dysfunction).
Collagenase Clostridium Histolyticum (CCH) therapy has thus far proven to be the most effective non-surgical therapy to treat Peyronie’s Disease. The majority of patients diagnosed with Peyronie’s experience a uniplanar dorsolateral curvature, but other, atypical deformities occur, including ventral curvature, hourglass deformity, and a severely shortened penis. The purpose of this study was to determine if CCH injections are equally effective for men with atypical deformities as it is for those with more common curvature.
Who was included in the study?
- 65 men with atypical Peyronie’s deformities
- Curvature was 30-90 degrees
- Disease was stable (not changing)
- The men had not previously undergone surgery for Peyronie’s
- Men each 3 CCH injections at 4-week intervals with strong recommendations to perform modelling, stretching and vacuum therapy in between injections
What were the results?
There were no lasting adverse events from the injections and significant median curvature improvements were seen in patients with ventral curvature (-20), hourglass deformity (-20) and shortened penis (-15), indicating an overall success rate of 56%. Overall, findings suggested that CCH could effectively be used to correct curvature, even in men with atypical deformities.
Reference for Article
Cocci A, Di Maida F, Russo GI, di Mauro M, Cito G, Falcone M, Minervini A, Cacciamani G, Campi R, Mari A, Sessa F, Mondaini N. How Atypical Penile Curvature Influence Clinical Outcomes in Patients with Peyronie’s Disease Receiving Collagenase Clostridium Histolyticum Therapy?. World J Mens Health. 2019 Jan;37:e28. https://doi.org/10.5534/wjmh.190026