Introduction: There are a variety of treatment modalities available to treat Peyronie’s disease (PD), including collagenase clostridium histolyticum (Xiaflex) injections. Patients with concomitant erectile dysfunction (ED) and PD are best served by insertion of an inflatable penile prosthesis (IPP) in order to adequately treat both conditions. Many PD patients may undergo other PD treatments, including Xiaflex, prior to IPP implantation. Little data exists regarding whether Xiaflex treatments prior to IPP placement influence changes in penile curvature during and after IPP surgery with manual modeling.
Objective: The primary objectives were assessing the impact of pre-treatment with Xiaflex on penile curvature immediately after IPP implantation and after manual modeling. The secondary objective was change in penile curvature postoperatively.
Methods: All IPP patients with known preoperative penile curvature with and without a history of Xiaflex injections undergoing IPP placement by a single surgeon from January 2017 to June 2023 were included in this IRB-approved (IRB 00031589) retrospective series. All patients had a 3-piece Coloplast Titan Touch IPP (Coloplast, Minneapolis, MN, USA) ranging 16-24cm in length (mean 19.8 ± 1.9cm) with 0-3cm rear tips (mean 1.4 ± 0.9cm). Goniometer was used to assess curvature during preoperative intracavernosal injection and duplex Doppler ultrasound, at multiple points intraoperatively, and postoperatively at 2 weeks, 6 weeks, and 6 months.
Results: Sixty-one patients were included. Preoperative curvature was 35° ± 17° (10° to 70°) for the Xiaflex cohort (n=11) and 41° ± 15° (20° to 80°) for the Xiaflex naïve cohort (n=50). At the time of IPP placement, patients previously treated with Xiaflex had a 19° ± 12° absolute reduction in penile curvatures, corresponding to a 45% ± 36% improvement, while Xiaflex naïve patients had a 20° ± 13° absolute reduction and 54% ± 23% improvement. Similar mean curvature reductions were seen with IPP placement regardless of curvature direction. There was little difference in change in curvature after modeling between the Xiaflex (11° ± 3°, 63% ± 23%) and Xiaflex naïve patients (14° ± 9°, 70% ± 20%). Interval assessments postoperatively were also comparable.
Conclusions: Preoperative treatment of PD with Xiaflex does not impede nor significantly improve curvature correction with IPP implantation and manual modeling. Similar changes in penile curvatures were seen in both groups regardless of curvature direction, modeling, or postoperative interval. In patients with severe PD, Xiaflex may be a useful tool to improve preoperative penile curvatures such that they may be more easily correctable with an IPP.
