AB005. Treatment of Peyronie’s disease: 2016 updates

The approval of Xiaflex (collagenase clostridium histolyticum) by the FDA in the US in December of 2013 has significantly changed the management of Peyronie’s disease. Based on author’s experience in treating the disease for more than 25 years and giving more than 1,000 Xiaflex injections, a refined medical and surgical approach is proposed. (I) Detailed history and focused physical examination: should obtain the following critical information: duration of disease, symptoms (the tetrad of pain, deformity, plaque, and erectile dysfunction), prior treatment and outcome, emotional stress and expectations; (II) physical examination: thorough examination of the genitalia, hands and feet if history suggests. The number, size, consistency, and location of plaques, local tenderness should be documented; (III) assessment: evaluate and document penile deformity and erectile function- by patient’s own erection photos, erection in clinic by manual stimulation, as well as oral or injection of vasoactive agent. A high-resolution penile ultrasound is a valuable tool in identification of septal fibrosis, calcification, and intracavernous fibrosis; (IV) discussion of therapies at first visit: we recommend pentoxifylline for 3 to 6 months in men with the following: recent onset (a few months), calcifications, pain, and tenderness. The goal is to stop progression of deformity and calcification and give the patient some time to understand the more effective but more invasive therapies; (V) discussion of more invasive therapies: pentoxifylline + vacuum device or penile stretching device; collagenase (Xiaflex) injection + modeling, plication surgery, extratunical grafting surgery, tunica-sparing excision of ossified plaque, penile prosthesis. More detailed discussion and clinical examples will be presented at the meeting.