Introduction: Injection of Clostridium Histolyticum (Xiaflex®, CCH) has become increasingly more common since its FDA approval for non-surgical treatment for Peyronie’s Disease (PD) in December 2013. We evaluated practice patterns for PD in the Xiaflex® era and the outcomes for penile plication (PP) after CCH failure at our tertiary referral center.
Methods: We performed a retrospective study of our single-surgeon PP database from 2013-2021. Patients who underwent PP were stratified by history of CCH treatment for PD. Variables compared included number of CCH cycles, time from CCH to PP, change in degree of curvature, and need for revision plication. The EPIC SlicerDicer program was used to identify all clinic visits with a primary PD diagnosis using ICD-10 code N48.6. Two-tailed t-tests for continuous variables were performed using PRISM 9.2.
Results: The annual number of clinic visits for PD during the study period nearly doubled (242 in 2013-14 vs. 436 in 2019-20, p <0.01). The annual number of PPs performed and the proportion with prior CCH failure escalated at a similar rate (Figure 1). Among 43 men who underwent PP after prior CCH treatment, a mean of 3.6 treatment cycles (range 1 – 6) were completed with an average time from final CCH treatment to PP of 13.0 months (range 4 – 25). Patients frequently reported no change (19/43 41.3%) or mild improvement (12/43, 26.0%) following CCH treatment. Worsening curvature (8/43, 17.4%) and corporal rupture (2/46, 4.3%) were also reported after CCH. Mean pre-CCH curvature was 61.6° ± 20.7° with an average improvement of 13° ± 17° with CCH. PP further improved curvature by 49° ± 20° with residual curvature of 3° ± 7°. There was no significant difference in the need for revision PP between the CCH and non-CCH groups (2/43, 4.7% vs. 14/372, 3.8%, p <0.01).
Conclusions: The introduction of CCH for the treatment of PD has led to a significant increase in clinic visits for surgical consultation and PP in patients with previous CCH failure. Post-CCH PP appears to be feasible and safe with overall excellent improvement in curvature.
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