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Peyronie's disease (PD) affects up to 9% of the male population. PD causes scarring of the tunica albuginea of the penis which leads to penile deformity making sexual intercourse difficult or impossible. PD also causes significant psychological, emotional and relationship difficulties for both patient and partner. Up until the licencing of Collagenase clostridium histolyticum (CCH) (Xiapex®, Xiaflex®), surgical correction of the penile deformity was the mainstay of treatment. Many conservative treatment options had been previously tried, however, the safety and efficacy of these options has not been demonstrated in large well-designed clinical trials. Intra-lesional CCH is now the gold standard option for the non-surgical management of PD. It is the first and only FDA (Food and Drink Administration) and EMA (European Medicines Agency) approved treatment for PD. In this review article, we will discuss the pharmacology, clinical efficacy, safety and future of CCH intralesional injection.

MEDLINE and PubMed search (from 1946). The search terms (Collagenase Clostridium Histolyticum OR Xiapex OR Xiaflex) AND Peyronie's disease were used.

The safety and efficacy of intra-lesional CCH in the management of PD has been demonstrated in 2 large-scale multi-centre, randomised, double-blind placebo- controlled clinical trials; the investigation for Maximal Peyronie's Reduction Efficacy and Safety Studies I and II (IMPRESS I and IMPRESS II). A new study published by our group suggests a new modified shortened protocol that will reduce the cost and duration of treatment without compromising the safety or efficacy of treatment.

CCH is the gold standard non-surgical option in the management of PD. The safety and efficacy of CCH has been demonstrated in large well-designed clinical trials. The new modified protocol, developed by our group, reduces the cost and inconvenience to patients whilst maintaining the efficacy. This will allow more men to benefit and will reduce the number of men undergoing surgical correction for their PD.

Minerva urologica e nefrologica = The Italian journal of urology and nephrology. 2018 May 14 [Epub ahead of print]

Amr Abdel Raheem, Mark Johnson, David Ralph, Giulio Garaffa

The Institute of Urology & University College London Hospital, Andrology Department, London, UK - ., The Institute of Urology & University College London Hospital, Andrology Department, London, UK.

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