Editing Peyronie's Disease (section)

===== Intralesional injection =====
# '''<span style="color:#ff0000">Clostridial collagenase (Xiaflex) with penile modeling</span>'''
#* Produced by the bacterium C. histolyticum
#* Selectively degrades collagen types I and III in connective tissues
#* '''<span style="color:#ff0000">Associated with:</span>'''
#*# '''<span style="color:#ff0000">Decrease in deviation angle</span>'''
#*# '''<span style="color:#ff0000">Reduction in plaque size</span>'''
#** '''<span style="color:#ff0000">Does NOT treat pain or ED</span>'''
#* '''<span style="color:#ff0000">Appropriate in patients with (2)</span>'''
#*# '''<span style="color:#ff0000">Curvature >30° and <90°</span>'''
#*# '''<span style="color:#ff0000">Intact erectile function (with or without the use of medications)</span>'''
#** '''<span style="color:#ff00ff">IMPRESS I & 2</span>'''
#*** '''832 PD patients with (4):'''
#***# '''Stable disease'''
#***#* Use in active phase is considered off-label
#***# '''Curvature > 30° and < 90°'''
#***# '''Single dorsal or lateral plaque'''
#***# '''No isolated hourglass deformity or calcified plaque'''
#***# '''Normal erectile function'''
#*** Randomized to intralesional collagenase vs. placebo
#*** Results:
#**** In both trials, men in the CCh group were shown to exhibit a 17° improvement in penile curvature compared to 9° in the modelling only, placebo group, '''modest absolute difference 8'''°
#** '''To-date, clinical trials have not evaluated the use of collagenase in patients with (5):'''
#**# '''Hourglass deformity'''
#**# '''Ventral curvature'''
#**# '''Calcified plaque'''
#**# '''Plaque located proximal to the base of the penis'''
#**# '''Curvature < 30° and > 90°'''
#* '''<span style="color:#ff0000">Adverse events (5):'''
#*#'''<span style="color:#ff0000">Corporal rupture'''
#*#*'''Extremely rare; will often necessitate surgical repair'''
#*#'''<span style="color:#ff0000">Penile bruising'''
#*#'''<span style="color:#ff0000">Penile pain'''
#*#'''<span style="color:#ff0000">Penile swelling'''
#*#'''<span style="color:#ff0000">Hematoma'''
#* '''<span style="color:#ff0000">Should be combined with penile modeling</span>''' by the physician and patient
#* Discontinued in Europe and Canada in 2020 due to cost and poor market uptake§
# '''<span style="color:#ff0000">Calcium channel blocker</span>'''
## '''<span style="color:#ff0000">Verapamil</span>'''
##* Affects fibroblast function on several levels, including cell proliferation, ECM protein synthesis and secretion, and collagen degradation
##* Evidence for the use of intralesional verapamil is weak
##* '''Poor candidates include those with:'''
##*# '''Extensive calcification'''
##*# '''Curvature >90°'''
##*# '''Ventral curvature''' (difficult to adequately infiltrate the plaque)
##* '''Predictors of success include:'''
##*# '''Younger age (age < 40)'''
##*# '''Curvature >30°'''
##* '''Adverse Events (4):'''
##**'''Penile hematoma'''
##**'''Pain'''
##**'''Dizziness'''
##**'''Nausea'''
## Nicardipine
##* Demonstrated significant reduction in pain, improvement in IIEF-5 score, and reduction of plaque size when compared to placebo
# '''<span style="color:#ff0000">Interferon alfa-2b</span>'''
#* '''Efficacy'''
#**'''Used to reduce curvature, plaque size, pain, and improve some vascular outcomes'''
#**'''Modest improvement compared to placebo'''
#* '''Indications'''
#**'''Curvature > 30° and without calcified plaque'''
#* '''Adverse Events'''
#**'''Sinusitis'''
#**'''Flu-like symptoms of arthralgia'''
#**'''Fevers'''
#**'''Chills'''
#**'''Local effects including penile hematoma, swelling, and pain'''
#*'''Significant cost and side effects'''
#**Rarely used in Canada
*'''Corticosteroids'''
** '''Not recommended''' for intralesional treatment of Peyronie disease
* '''Hyaluronic acid and botulinum toxin A (onabotulinum toxin A)'''
** '''Too early to make any recommendations''' on the use of these medications until more safety and efficacy data are available
* '''Platelet-derived growth factors (platelet-rich plasma)/'''Priapius ShotTM protocols and stem cell therapy
** Patients should be counselled regarding the '''lack of efficacy data'''.