Xiaflex Specialist in Indianapolis, IN

The fellowship-trained urologist Dr. Tatem at Urology of Indiana specialize in providing comprehensive care for patients suffering from Peyronie’s disease in Indianapolis, IN. They will take the time to provide you with a comprehensive diagnosis and answer any questions you may have about Xiaflex. For more information, please feel free to call our Men’s Health Center in Indianapolis, IN at (317) 564-5104.

What is XIAFLEX® and how is it used?

Xiaflex (also known as collagenase clostridium histolyticum) is an injectable medication designed to help break down scar tissue. In men with Peyronie’s disease, the penis becomes curved or deformed as the result of scar tissue that’s formed in the casing that makes up the
erectile tubes of the penis. When combined with traction therapy, XIaflex can help break up that scar tissue and straighten erections without the need for surgery.

Xiaflex is administered in a series of penile injections that are broken up into ‘cycles.’ These are performed in the office and are directed precisely into the scar tissue caused by Peyronie’s disease. An entire treatment course involves a total of 8 injections spread out over about 5-6 months.

How do treatment cycles work?

Xiaflex injections are performed on a regular schedule at set intervals. Each interval is known
as a cycle. A typical cycle looks like this:

The First Xiaflex Injection

• This is performed in the office during what is typically a 30-minute visit.
• To start, an artificial erection is induced. This is done with an injection of some pro-erectile medication like Bimix or Trimix.
• The penis and the curve are formally measured and the area of curvature is then marked with a marker. The erection is then reversed through a second injection of dilute phenylephrine.
• The Xiaflex medication is injected directly into the plaque. This can be uncomfortable, but the discomfort goes away quickly for most men.
• The penis is wrapped with a bandage to reduce swelling.
• Men are then sent home with instructions to not remove their bandage or shower until their next injection in 1-3 days.

Second Xiaflex Injection

• This is performed about 1-3 days after the first injection.
• The dressing from the first visit is removed and the injection site is examined.
• Provided there is not excess swelling, the second Xiaflex injection is then performed that day.
• Men with significant swelling may be asked to delay their injection until the following week.

Healthcare Provider Traction (aka Stretching or Modeling)

• The third step is traction of the Peyronie’s scar tissue (aka stretching or modeling) performed by the person who administered the injections.
• This is often performed immediately after the second injection on that same day.
• However, in some cases it may be performed during a third visit about 1-3 days after the second injection.
• Another bandage is applied before men go home and, if it is their last clinic visit of that cycle, they are instructed to remove the bandage themselves 2 days later in the shower.

Traction Performed At Home

• Once the bandage has been removed at home, men are instructed to start their own penile traction therapy.
• This can be performed using a dedicated traction device like RestoreX or with manual hand exercises if a traction device is not an option.
• These exercises continue for 6 weeks, which concludes the ‘treatment cycle.’ Men then return to the clinic to start their next cycle.
• It should be noted that men must avoid sexual activity for 4 weeks following their second Xiaflex injection to reduce the risk of penile injury. The penile tissue is still considered fragile during this time.

The above ‘cycle’ is performed for a total of 4 times and each ‘cycle’ takes about 6-7 weeks. Men who choose Xiaflex therapy are strongly encouraged to complete all 4 cycles as research has shown continual improvement can still be achieved with each subsequent cycle.

How important is traction therapy with XIAFLEX®?

Traction therapy, either with a dedicated traction device or manual exercises performed by hand, is an absolutely essential part of treatment with Xiaflex. Xiaflex ‘softens’ the scar, which makes traction therapy more effective, but ultimately it is the traction exercises themselves that straighten the penis. Studies have shown that treatment with Xiaflex in men who do not perform traction therapy provides very little, if any, improvement in penile curvature.

How much improvement can I expect?

Xiaflex can help men achieve significant curvature improvement without the need for surgery. When combined with traction therapy performed by hand (manual modeling) most men will achieve about a 30% improvement in curvature. When combined with traction therapy
performed with a device, many men can achieve curvature improvement closer to 50%. Treatment with Xiaflex is ideal in men with good erections and curvature that is associated with a palpable plaque without complicating deformities like profound ‘waisting’ or narrowing.
Men who don’t meet this criteria may not have the same success rates.

What can I expect during XIAFLEX® treatment?

Xiaflex works by softening tissue. As a result, it can cause soreness that may last for a few days following each injection. This discomfort is typically quite mild and easily managed with overthe-counter anti-inflammatories like ibuprofen (aka Motrin) and acetaminophen (aka Tylenol). However, most men won’t need any medication at all.

Bruising and swelling is quite common with Xiaflex and should be expected. Almost all men will have some degree of bruising. This can be mild and resemble a dark blotch at then injection site or be more pronounced and involve the majority of penile shaft with associated swelling. Some men will even report that their penis ‘looks like an eggplant.’ Although this can be alarming to some men, rest assured that even the worse bruising will resolve with supportive underwear and time. If you ever have any questions or concerns, please don’t
hesitate to reach out to our office at (317) 564-5104.

What side effects should I watch out for?

The most concerning potential side effect of Xiaflex treatment is a type of penile injury known as corporal rupture or penile fracture. This type of injury can occur in men who participate in sexual activity prematurely during the first 4 weeks following their Xiaflex injections when sex and masturbation should be completely avoided.
Because Xiaflex works by softening tissue, it temporarily weakens the erectile cylinders that create erection. These cylinders are put under pressure during sex and masturbation. When they are temporarily weakened from Xiaflex therapy, they are at risk for injury until they’ve
had time to heal.
This is why it is so important for men to abstain from sex or masturbation during the 4 weeks immediately following their Xiaflex injections. Although this type of injury is still possible even in men who are past the 4-week mark, it is incredibly rare. Again, if you ever have any
questions or concerns, please don’t hesitate to reach out to our office.