Peyronie’s Treatment with Xiaflex®

Collagenase Clostridium Histolyticum (CCH) (Xiaflex®) is the first and only FDA approved medication for the treatment of Peyronie’s disease.  Xiaflex® is indicated for men with at least 30 degree curvature in their penis with minimal or no plaque calcifications seen on penile duplex ultrasound.

In clinical studies, Xiaflex® has been shown to significantly improve the degree of curvature and bother due to Peyronie’s disease.  It is administered by Dr Karpman in the office.  The patient receives two injections per cycle approximately one week apart.  The patient returns to the clinic one week after the second injection for penile stretching and straightening.  Oftentimes, Dr Karpman will recommend a penile traction device for use 2 weeks after the final injection for further correction of the Peyronie’s disease curvature.  A maximum of 4 cycles can be done to correct the penile angulation.

Xiaflex® is covered by Medicare and most PPO health insurance plans. Dr Karpman’s office will check your insurance benefits prior to scheduling your injections so that you are aware of any out of pocket costs for the procedure.

Patients who receive Xiaflex® are not allowed to have sex or masturbate for 2 weeks after the final injection.  Penile fracture has occurred in clinical studies in men who had sex within 2 weeks of their final injection.  The actual incidence of this occurrence is very low and listed below.

Below are pictures of a patient before and after Xiaflex® treatment.

IMG_1443              post Xiaflex 1


          Before                                                                 After      


Corporal rupture (penile fracture) was reported as an adverse reaction in 5 of 1044 (0.5%) XIAFLEX-treated patients in clinical studies. In other XIAFLEX-treated patients (9 of 1044; 0.9%), a combination of penile ecchymoses or hematoma, sudden penile detumescence, and/or a penile “popping” sound or sensation was reported, and in these cases, a diagnosis of corporal rupture cannot be excluded. Severe penile hematoma was also reported as an adverse reaction in 39 of 1044 (3.7%) XIAFLEX-treated patients.

Signs or symptoms that may reflect serious penile injury should be promptly evaluated to assess for corporal rupture or severe penile hematoma which may require surgical intervention.

Because of the risks of corporal rupture or other serious penile injury, XIAFLEX is available for the treatment of Peyronie’s disease only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the XIAFLEX REMS Program.