Xiaflex

An effective injectable therapy treating Peyronie’s disease

Xiaflex is an injectable therapy used to treat Peyronie’s disease, which is a hard scar or “plaque” that can form under the skin along the penile shaft to create a curve or bend. Peyronie’s disease typically begins as inflammation, but later develops into the hard scar tissue for which it is known. This condition can be painful, particularly during an erection and/or intercourse when the scar tissue can be felt acutely.

Peyronie’s disease is generally believed to develop from a previous injury to the penis, but genetics are also considered to play a part as men with a family history of the disease are at a higher risk to develop it. Health concerns like diabetes and tobacco use are also considered to be common factors in the occurence of Peyronie’s disease.

Choose Male Fertility & Sexual Medicine Specialists for Xiaflex Treatment

Male Fertility & Sexual Medicine Specialists offers patients advanced urology care, which includes the treatment of Peyronie’s disease using Xiaflex therapy. Dr. Bastuba and Jennifer LeVine, PA-C see hundreds of patients each year who seek Peyronie’s disease treatment and travel to the Male Fertility & Sexual Medicine Specialists for expert care.

Xiaflex Treatment of Peyronie’s Disease FAQs

Xiaflex is an injectable medication that works to break down the tough plaque/scar tissue caused by Peyronie’s disease. Xiaflex is a collagenase medication, or enzyme that breaks the peptide bonds of collagen (the plaque/scarring) and decreases the curvature of the penis over time. Xiaflex therapy currently consists of four treatment cycles. The total number of cycles may be determined by your initial response to the injection. Typically, each Xiaflex cycle takes about 4-6 weeks to complete. Patients can have up to four treatment cycles for each Peyronie’s plaque.
Some researchers believe Peyronie’s disease develops after an injury that causes bleeding inside the penis. This could explain cases of Peyronie's that develop quickly, but it does not explain why most cases develop slowly, or what causes the disease after no clear injury.

Most researchers believe that genetics or the environment may play a role. Men with certain connective tissue disorders and men who have a close family member with Peyronie’s disease are at greater risk.

If the disease heals within a year or so, the plaque usually does not get worse. However, when the disease lasts for years, the plaque often becomes a tough, fibrous tissue, and calcium deposits may form.
The natural history of Peyronie’s disease is unique in that spontaneous improvement is not uncommon. When a patient has active Peyronie’s disease, the chance of spontaneous improvement is 20%, stabilization is about 40% and further progression is about 40%. Therefore, only 20% (one in five) men suffering from Peyronie’s disease will get better. It is not unreasonable to implement Xiaflex therapy at any time if significant symptoms are occurring. If the disease heals within a year or so, the plaque usually does not get worse. However, when the disease lasts for years, the plaque often becomes a tough, fibrous tissue, and calcium deposits may form.
The penis expands in diameter and length as it fills with blood during the start of an erection. Peyronie’s plaque (scar tissue) keeps that part of the penis from expanding, causing that area to be shorter. The difference in length between a fully erect penis and the contraction due to plaque causes the bend or curvature of the penis.
Our staff will review your medical and sexual history and perform a physical exam, during which the plaque can usually be felt. Other tests may include:
- Ultrasound of the penis: An imaging technique that uses high-frequency sound waves to create pictures of the inside of the penis and checks blood flow. It also provides a clear picture of the size and density of the penile plaque and if the plaque is calcified.
- To check how the penis looks during an erection, medication may be injected into the penis to cause an erection in the clinic.
- Digital photos of your erect penis (top and side view only) are helpful for review.
Yes, Xiaflex is approved by the FDA.
Success rates can vary, but we’ve provided some useful statistics on Xiaflex success rates below*:
- 57% of men treated with Xiaflex who were originally unable to have sexual intercourse prior to treatment were able to perform after Xiaflex treatment
- 33% of men treated with Xiaflex noted improved penile sensitivity
- 67% of men treated with Xiaflex who were unable to have sexual intercourse prior to treatment were now able after 1 treatment cycle
- 92% of men were able to have sexual intercourse after completing their Xiaflex treatments
- 67% of men said they were extremely satisfied with their treatment
- 71% of their partners said they were extremely satisfied with their partner’s treatment
M. Ziegelmann et al, Minnesota Mayo Clinic 2016
E Traore et al, New Orleans Mayo Clinic, 2016
The majority of men describe Xiaflex treatment as quite tolerable, with mild discomfort in the initial minute or so post-injection. General anesthesia is not used during the procedure, but a local anesthetic can be used if needed. This injection can be given in office, with patients able to walk out on their own within minutes.
Patients are asked to absolutely abstain from intercourse for two weeks after each Xiaflex injection due to the risk of penile fracture. You are able to return to work immediately post-injection and can enjoy contact sports (excluding sex), though a protective undergarment is recommended.
Common side effects of Xiaflex injections can include swelling, bruising, discomfort and tenderness at the injection site, painful erections and problems obtaining an erection, a small collection of blood at the injection site (hematoma), color changes to the skin on your penis, itching sensation on the penis, blisters at the injection site, painful intercourse and/or a lump (nodule) at the injection site.
Most insurance providers will cover Xiaflex treatment, but out-of-pocket expenses will be determined by your coverage.
Dr. Bastuba has advanced training as an urologist. He completed a fellowship at Boston University in sexual medicine. Dr. Bastuba has treated thousands of patients with Peyronie's disease over his 25 years of urology services. Dr. Bastuba and his physician assistant, Jennifer LeVine, use their knowledge base to assist men throughout the United States suffering from Peyronie's disease.