I see men every day with concerns regarding a curved or crooked penis. Recently, I was featured on the Better Man podcast, where we comprehensively reviewed various options for Peyronie’s Disease. I see a number of men, who were seen by their primary care provider or even another Urologist and offered little hope for this devasting medical condition. Many of these men have some knowledge regarding collagenase injections or Xiaflex, the only FDA approved treatment for Peyronie’s Disease. This is largely because of considerable direct to patient advertisements through the internet, TV, radio about the “bent carrot.”

There is a lot of great information about collagenase injections and I routinely offer it to appropriate patients. This is a proven treatment that can help improve the curvature or deformity without surgery! Xiaflex is different as it is an enzyme that dissolves collagen, the primary component of Peyronie’s plaques. But not all plaques are the same and a careful examination and/or ultrasound completed by a Urologist with extensive experience with Peyronie’s Disease can help determine whether or not you are a good candidate for Xiaflex.

Many patients are surprised to learn the dramatic differences in success with injections vs surgery. In reality, there is not much reliable information on Peyronie’s Disease surgery, primarily because it is highly specialized area of Urology. There are many myths about Peyronie’s Disease surgery – who would want to get surgery on their penis if they had another option, but there are certain patients that may benefit from surgery.

1.     Men with very severe curvature: In certain men, Xiaflex treatments can provide curvature improvement up to 20-30 degrees. Unfortunately, in men with very severe curvature (>60 degrees or more), realistically, Xiaflex alone is unlikely to provide a satisfactory improvement. Even when combined with traction therapy, many of these men may require additional treatment(s). Especially in men with 90 degrees or more of curvature this is a very important conversation to have.     

2.     Failed Xiaflex injection therapy already: I see many men, who completed a treatment course of Xiaflex with minimal improvement in their curvature. Despite the disappointment, these men have lost almost 6 months of time with respect to restoring their sexual function. Although additional Xiaflex could be considered, surgical therapy would be immediately effective with fairly minimal recovery period, allowing you to get back to your life faster!   

3.     Insurance does not cover Xiaflex: Xiaflex is a very expensive medication. Although it is the only FDA approved treatment for Peyronie’s Disease and has good coverage with most commercial insurance carriers, those with primary state or federal insurance (Medicaid, Medicare) may have significant out of pocket costs. Similarly, I’ve seen patients turned away by prior Urologists because they were not approved for Xiaflex and given little hope for resolution of their condition. Surgery could be a good option for these men.      

Many men come in asking about other “alternatives” for Peyronie’s Disease. Oral medications, shockwave therapy, stem cell treatments, platelet rich plasma, exosomes, etc. do not have any good evidence that they are effective for the treatment of Peyronie’s Disease (improving the curvature or the decreasing the size of the plaque). Although there may be some unique situations where some of these treatments can be considered, realistically, they will not provide the results and satisfaction men seek in terms of restoring their function.

Peyronie’s Disease does not always require treatment, but if it is bothersome to you and your partner, there are several proven treatments available, both non-surgical and surgical. Please contact us to schedule a consultation to discuss your individual case and help reach your goals!  I am a recognized Peyronie’s Disease expert.