Xiaflex for Peyroine’s Disease, Caveat Imperator (or let the buyer beware)

Peyroine’s disease is a common malady of penile curvature that impedes normal sexual intimacy and affects millions of American men. One of the treatment options for Peyroine’s disease is Xiaflex. Xiaflex can cause serious side effects, including penile fracture, which is a medical emergency often requiring surgery to repair the fracture. After treatment with Xiaflex, the erection tissue in the penis may break during an erection. This is called a penile fracture.

After treatment with Xiaflex, blood vessels in your penis may also break, causing blood to collect under the skin which is referred to as a hematoma. This could also require a procedure to drain the blood from under the skin

Other serious injury to your penis may include a popping sound or sensation that may occur with an erection, sudden loss of the ability to maintain an erection, pain in your penis, purple bruising and swelling of your penis or even difficulty urinating or blood in the urine.

I suggest that you call your urologist if you have any of the symptoms of penis fracture or serious injury to the penis.

The manufacturer of Xiaflex recommend that you not have sex or any other sexual activity between the first and second injections of Xiaflex.
The manufactures also recommend that you not have sex or have any other sexual activity for at least 2 weeks after the second injection of a treatment.

Xiaflex is a prescription medicine used to treat adult men with Peyronie’s disease who have a curve in their penis greater than 30 degrees when treatment is started.

Bottom Line: Peyroine’s disease is a plaque formation in the penis that results in bending or curvature of the penis that can impair the ability to engage in sexual intimacy with your partner. One option is Xiaflex injections into the plaque. However, these injections are not without risks ad complications include penile fracture, which is a medical emergency. For more information speak to your doctor.

 

 

2016 Update of Peyronie’s Disease (PD)

PD is a health issue in which a scar or plaque forms under the skin of the penis. Most of this plaque builds up leading to a curved erection, which can make intercourse difficult or painful for a man and his partner. PD is thought to impact about 6% of men between the ages of 40 and 70 years of age. This may be an underestimate as many men are too embarrassed to seek help or report the problem to their physician.

Doctors do not know what causes PD or how to prevent the disease before it starts. We do know that PD runs in the family. We also know that forceful sexual activity causes minor injuries to the penis that may initiate the process of scar formation. The disease is not related to a sexually transmitted disease or is a source of cancer.

The symptoms of PD include a curvature of the penis. A man may also be able to feel one or more hard lumps on the penis. Men may also experience painful erections and the man’s partner may also complain of vaginal pain or discomfort.

The treatment options for PD include watchful waiting, non-surgical treatments, and surgery. Watchful waiting is appropriate for a man with a minimal curvature that does not cause pain or impede sexual intimacy. Injection therapy includes the use of interferon\verapamil\collagenase drugs directly into the plaque, which may dissolve the plaque. Surgical options include straightening surgery or plication. The plaque can also be removed the defect repaired with a graft of human tissue or synthetic disuse. Finally the plaque can be removed and a penile prosthesis inserted. (See my website, http://www.neilbaum.com, for more information on Peyronie’s Disease and the use of a penile prosthesis)

Bottom Line: Peyronie’s disease is a common urologic disorder. It is a source of potential pain and discomfort. Help is available and most men can achieve relief from the disabling curvature.

 

Curves Belong on Baseballs Not On Penises

Peyroine’s disease affects millions of American men. The problem consists of curvature of the penis that can make erections difficult or even painful to the man and his partner. Now there is a new FDA approved treatment for this common urologic condition.

Peyronie’s Disease is a local connective tissue disorder characterized by a change (scar formation) in the collagen composition of the tunica albuginea of the penis.

The two corpora cavernosa and corpus spongiosum of the penis are composed of an elastic covering within the tunica on top of the erectile-spongy tissue inside. During an erection, blood is trapped in all three corporal bodies leading to dissension of the corpora and an erection occurs. Peyronie’s plaque, which is composed predominately of collagen, although calcium deposits may occur, replaces the normal elastic tissue. This results in penile deformity, primarily a curvature (I have seen up to 120 degree bends!); along with penile narrowing, indentation and shortening of the penis.

Causes of Peyroine’s Disease

Microvascular trauma resulting from excessive bending or injury to the penis (possibly during sexual activity) is thought to be an important trigger for the inflammatory response and plaque development. Genetic pre-disposition and autoimmunity may also play a role in the development.
• Sexual intercourse: As one can imagine, the deformity can result in inability to penetrate or function properly. If the deformity is severe enough, pain to the partner as a result of the penile glans pushing on the vaginal vault side wall can occur.
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• Erectile dysfunction: An increase in incidence of erectile dysfunction has been associated with Peyronie’s Disease. With the use of PED5 inhibitors or 2nd/3rd tier treatments, a more rigid erection can result which can lead to an exacerbation of the penile deformities.
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• Psychological: As one can imagine, the potential psychological effects to a man can be devastating. Recent studies showed that 48% of men with Peyronie’s Disease were found to have clinically meaningful depression.
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Treatment Options

Antiquated treatments, including Vitamin E, Potaba, and anti-inflammatories, have been tried but have not been shown to be clinically effective. 

Penile injections of steroids and Interferon have been used with limited success. Probably the gold standard has been the use of Verapamil injections into the plaque. This has been reported, with and without the use of a vacuum erection device, to improve the deformity in some men. This requires a penile block followed by injection of 10-20 mg. of Verapamil every other week for a total of 12 treatments. Studies have reported a 30 degree improvement in the curvature in some men. 

The basis of the use of Verapamil is that it breaks up the collagen fibers leading to an improvement in the deformity. A number of compounding pharmacies have attempted to create a Verapamil cream to replace the intra-lesional injection of Verapamil with limited success. 

Surgical options include a simple procedure in which stitches are used to straighten the penis but this does result in some shortening of the erection (about an inch or so). The only other option is a penile prosthesis which for some men with associated ED is a viable treatment. However, placing implants with Peyronie’s is not necessarily an easy procedure. 



New Treatments


Xiaflex (collagenase clostridium) has been approved in the past for the treatment of Dupuytren’s contractions with significant success. The theory is that the collagenase breaks up the collagen fibers resulting in a relief and improvement in a deformity associated with this condition. 

Recently, Texas Urology participated in a clinical trial with use of Xiaflex for Peyronie’s Disease. Based on the results of two studies involving over 600 men, Xiaflex has been approved for the treatment of Peyronie’s Disease. In the two clinical trials, a 35% improvement was noted in men with a penile deformity of at least 30 degrees (placebo improvement approximately 20%). Additionally, there was an improvement in the Peyronie’s bother domain compared to placebo. 

Corpora rupture (penile fracture) was reported in 0.5% of men with Xiaflex. Additionally, greater than 25% of the men reported an incident greater than placebo of penile hematoma, penile swelling and penile pain.

In Xiaflex administration/home treatment, a solution of 0.25 cc of reconstituted collagenase is injected into the plaque at the point of maximum deformity (based on a pharmacological-induced erection). A second injection into the plaque is repeated 1-3 days later both in the office. The patient returns to the office 1-3 days later for penile modeling which involves stretching the penis in the flaccid state along with bending for approximately 30 seconds and then repeated twice with 30 second rest periods. The patient then proceeds for six weeks to perform penile modeling activities at home which include stretching the penis for 30 seconds, three times a day and penile straightening at least once a day for 30 seconds. The patient should abstain from sexual activity for at least two weeks. Up to four treatment cycles may be administered per plaque. 

The treatment should not be attempted for ventral plaques but only for dorsal plaques because of the urethral location ventrally. 




Xiaflex appears to be of benefit to men with significant penile deformities (greater than 30 degrees) who are interested in improving their curvature. The cost of Xiaflex per treatment cycle is $3,900 per treatment course cash price. Since it is a new medication insurance coverage will take time, but supposedly it is covered by Medicare. Remember it could take four courses! 

This could be a high price to pay in many ways, but for men with a significant problem it may be well worth it.

Bottom Line: Peyroine’s is a common urologic condition that can wreck havoc on man’s sexual performance. Now there are new and successful treatments for this condition. Speak to your urologist.

Sex and The Male Senior Citizen

Couple In Love

You are 60 years of age and you note that your erections are not as strong as there were at 40 years of age. It takes longer to get an erection than a decade ago and once you ejaculate it takes longer to get the next erection. Welcome, guys to the middle ages. These are normal consequences of aging for men. This doesn’t mean that you pack up your penis and never use it again. It means that you will use it differently than years ago.

What are the normal, expected changes in a man’s penis as he ages?

Appearance. There are two major changes. The head of the penis (glans) gradually loses its purplish color, the result of reduced blood flow. And there is a slow loss of pubic hair. You don’t have to worry about your manscape as nature will take care of your pubic hair for you.

Penis Size.
Weight gain is common as men grow older. As fat accumulates on the lower abdomen, the apparent size of the penis changes. A large clump of fat in the lower abdomen makes the penile shaft look shorter. If you want a bigger penis, check out your core and trim it down and your penis will grow larger….or at least it will appear to be longer.
In addition to this apparent shrinkage (which is reversible) the penis tends to undergo an actual (and irreversible) reduction in size. The reduction — in both length and thickness — typically isn’t dramatic but may be noticeable. “If a man’s erect penis is 6 inches long when he is in his 30s, it might be 5 or 5-and-a-half inches when he reaches his 60s or 70s.
What causes the penis to shrink? At least two mechanisms are involved, experts say. One is the slow deposition of fatty substances (plaques) inside tiny arteries in the penis, which impairs blood flow to the organ. This process, known as atherosclerosis, is the same one that contributes to blockages inside the coronary arteries — a leading cause of heart attack.
Another mechanism involves the gradual buildup of relatively inelastic collagen (scar tissue) within the stretchy fibrous sheath that surrounds the erection chambers. Erections occur when these chambers fill with blood. Blockages within the penile arteries — and increasingly inelastic chambers — mean smaller erections.

As penis size changes, so do the testicles. Starting around age 40, the testicles definitely begin to shrink. The testicles of a 30-year-old man might measure 2 inches in diameter, he says; those of a 60-year-old, perhaps only 1.5 inches.

Curvature. If penile scar tissue accumulates unevenly, the penis can become curved. This condition, known as Peyronie’s disease, occurs most commonly in middle age. It can cause painful erections and make intercourse difficult. The condition may require surgery.

Sensitivity. Numerous studies have shown that the penis becomes less sensitive over time. This can make it hard to achieve an erection and to have an orgasm.

Libido or sex drive
As men get older the testosterone level falls. Testosterone is the hormone produced in the testicles that is responsible for the sex drive. It reaches a peak in the 20’s and early 30’s and slowly declines at a rate of 2% a year. Men who have this problem can obtain a blood test, a serum testosterone test, and if it is low and there is no history of prostate cancer, then the man can receive testosterone supplements in the form of an injection every two weeks, the application of a daily gel to the lower abdomen or shoulders, or the insertion of a pellet under the skin which lasts for 4-6 months.

Bottom Line: Yes, there are changes that are going to occur as a man ages just as there are changes in muscle mass, bone density, memory, hearing, and vision. But this doesn’t mean the end of a man’s sex life. With good health, a willing partner, and a desire to pleasure your partner, you, too, can enjoy sexual intimacy in your silver years.