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Aggressive CCH technique is linked to improved curvature in Peyronie disease


“With proper training and proper technique, there really can be drastic changes that can be made without having to do a surgical intervention,” commented first author Alissa Tyler, RN.

A more aggressive collagenase clostridium histolyticum (CCH, Xiaflex) injection/traction protocol is associated with improved penile curvature in men with Peyronie disease.

The research was presented during a podium presentation at the 2022 American Urological Association Annual Meeting in New Orleans, Louisiana.

The investigators’ injection protocol has evolved over time and comprises injection of 0.9 mg of CCH in 0.7 mL of saline into approximately 15-20 sites around the point of maximal curvature. These injections are performed on subsequent days, and very aggressive modeling encompassing 10-15 lbs of force is performed with the second injection. At 24 to 48 hours after the second injection, patients are counseled to begin RestoreX traction for 30 to 60 minutes daily. The investigators advised aggressive manual modeling to continue for at least the first week after injection. They performed a descriptive analysis to review outcomes.

The study cohort consisted of 438 men who underwent at least 1 series of CCH and had baseline and follow-up curve assessment data available. The patients had a mean age of 55.8 years, mean Peyronie disease duration of 32 months, and 64-degree median baseline composite curvature. The investigators reported that, using the definition of most recent curve assessment, mean composite curve improvements were 27.1 degrees (41%) with the more aggressive technique vs 17.8 degrees (24.6%, P <. 001). In men who completed all 8 injections or who stopped early due to satisfaction, mean improvement seen was 36.4 degrees (59%) vs 19.8 degrees (30.5%, P <. 001). Erection function, as assessed by the International Index of Erectile Function-Erectile Function Domain, was similar to baseline.

Landon Trost, MD

Landon Trost, MD

Discussing the findings, study co-author Landon Trost, MD, said, “The study wasn't real surprising, but it was more so when we started implementing it that you notice it right away in clinic, because we'd have patients who would send us pictures after the fact. And we had some that would get a single injection and were fully straight, which we'd never had before. And so we immediately knew that there was something to this.” Trost is the director of the Male Fertility and Peyronie’s Clinic in Orem, Utah.

Trost commented that although the aggressive technique has become the standard of care in his own practice, it should not be considered so elsewhere yet.

“We’re a real high-volume Peyronie [disease] center, and so we can get numbers a little bit more rapidly. But really, you need that external validation before you start having everybody do it,” Trost said.

Trost said his group is currently conducting a randomized trial of the technique in patients who had prior treatment failure with CCH.

“The preliminary data…is looking very similar to men who've never had any treatment before. It just emphasizes how technique is 1 important aspect of successful treatment with the drug,” Trost said.

Alissa Tyler, RN

Alissa Tyler, RN

Both Trost and first author Alissa Tyler, RN, emphasized the importance of technique in administering CCH.

“With proper training and proper technique, there really can be drastic changes that can be made without having to do a surgical intervention,” commented Tyler, a registered nurse at the Male Fertility and Peyronie’s Clinic.


1. Tyler A, Green B, Savage J, et al. Improved Peyronie's disease curvature outcomes using a more aggressive collagenase technique. J Urol. 2022;207(5S):e409. doi:10.1097/JU.0000000000002565.01

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