Ledesma, B, Zarli, M, Muthigi, A, Ziegelmann, M, Masterson, T

Xiaflex, Injections, Peyronie’s Disease, ICI

Peyronie's Disease (PD) is a connective tissue disorder that causes curvature and pain during erections. Collagenase clostridium histolyticum (CCH) is the only FDA-approved intralesional medication for PD, recommended to be injected at the point of maximal curvature. However, a 2019 survey found that physicians used various injection techniques, and it is unclear if any technique is superior. In this video we aimed to compare four different injection techniques for CCH to determine which one is most effective in delivering the medication to the PD plaque. PD plaques were obtained from men undergoing plaque excision and grafting. Plaques were stored at -80C and injected with 0.25ml of Eosin Y, 5 wt. 5% solution in water. The dye solution is red and similar to the density of CCH. The four injection techniques tested were single injection, single injection with slow pull back, multiple site injection, and lateral injection. All injections were video recorded in real time. The dye was retained inside the plaques for all injection techniques, but a significant amount leaked out. The multiple injection technique appeared to have the least amount of dye leakage from the plaque. In conclusion, we found that all four injection techniques tested for Collagenase Clostridium Histolyticum (CCH) resulted in some degree of dye leakage from the PD plaque. However, the multiple injection technique seemed to result in the least amount of dye leakage. It's important to note that these findings are from an in vitro study using PD plaques from men undergoing plaque excision and grafting. Therefore, it is unclear whether the results of this study translate to better clinical outcomes in CCH treatment of PD. We are currently working on further research to determine if this finding translates to better clinical outcomes in CCH treatment of PD.