A MULTIMODAL CONSERVATIVE TREATMENT PROTOCOL FOR PEYRONIE’S DISEASE FOLLOWING THE DISCONTINUATION OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM IN EUROPE

Following the discontinuation of Collagenase Clostridium histolyticum (CCH; Xiapex, Xiaflex) outside the USA, there has been a growing need for effective conservative treatment alternatives. This study evaluates the safety and efficacy and of a conservative multimodal treatment protocol for Peyronie’s disease.

A retrospective single-center study, conducted on 35 patients treated between January 2023 and August 2024. All patients completed a 3 month treatment protocol which consisted of; daily tadalafil 5 mg and Tamoxifen 20 mg twice daily, daily vacuum pump use for 30 min, RestoreX traction device use for 30 min and 12 sessions of low intensity shock wave therapy (LESWT) using the Storz Duolith machine (3000 shocks at an energy density of 0.35 mJ/mm2 focused on penile plaque).

The mean patient age was 49.8 years (range: 28–73). The mean PD duration was 8 (3-24) months. The mean curvature at baseline was 52.4° (range: 35°–80°). At the end of the study, the mean curvature was 35.8° (range: 25°–70°) which was a statistically significant difference. Of the 35 patients, 22 (63%) had stable disease and 13 (37%) were in the active phase. Treatment outcomes were as follows: there was a clinically significant improvement in 21 patients (60%), for whom no further treatment was necessary, mild improvement in 7 patients (20%) who required further treatment or resorted to surgical correction of the curvature and no improvement in 7 patients (20%) who resorted to surgical correction of the curvature. Eight out of the13 patients who were in the acute phase had significant improvement versus 13 out the 22 patients with stable disease (no statistically significant difference between both groups). No adverse effects were reported during the study period.

This study demonstrates that the conservative multimodal treatment protocol combining tadalafil, tamoxifen, VED, RestoreX, and LESWT is a safe and effective option for men with PD whether in the acute or chronic phase. Further multi-center studies are required to confirm the long-term efficacy of this protocol as a viable non-surgical alternative for PD management.

Non.