Peyronie’s disease (PD), a condition characterized by penile curvature, can be treated with various approaches, including collagenase clostridium histolyticum (Xiaflex) injections. For patients with both PD and erectile dysfunction (ED), an inflatable penile prosthesis (IPP) can address both conditions effectively. This study aimed to evaluate whether Xiaflex pretreatment affects penile curvature correction during and after IPP placement with manual modeling. A retrospective series was conducted on IPP patients with known preoperative curvature, some of whom received Xiaflex treatment prior to IPP surgery, performed by a single surgeon between January 2017 and June 2023. All patients received a 3-piece Coloplast Titan Touch IPP (length range: 16-24 cm, average: 19.8±1.9 cm), and penile curvature was assessed using a goniometer during preoperative intracavernosal injection and duplex Doppler ultrasound, as well as at multiple postoperative intervals (2 weeks, 6 weeks, and 6 months).
The study included 61 patients: 11 in the Xiaflex group and 50 in the Xiaflex-naïve group. Initial curvature was 35°±17° for Xiaflex-treated patients and 41°±15° for those without Xiaflex. Upon IPP placement, Xiaflex patients showed an average curvature reduction of 19° (45% improvement), while Xiaflex-naïve patients had an average reduction of 20° (54% improvement). Similar reductions were achieved across both groups, irrespective of curvature direction or postoperative interval. After manual modeling, curvature changes were comparable: Xiaflex-treated patients saw an 11° (63%) reduction, while Xiaflex-naïve patients saw a 14° (70%) reduction. Overall, Xiaflex did not significantly alter outcomes in curvature correction post-IPP, though it may serve as a helpful preoperative tool for severe PD cases to facilitate IPP correction.
