Landon Trost, MD, on CCH treatment vs surgery for Peyronie’s disease

Data presented at the 26th Annual Fall Scientific Meeting of the Sexual Medicine Society of North America suggest that men treated with Collagenase Clostridium Histolyticum (Xiaflex) for Peyronie’s disease were more satisfied with therapy compared with men who underwent surgery.¹

Specifically, at 36 months following treatment, 54% of men in the CCH arm reported being satisfied with treatment vs 8% of men in the surgery arm (P < .01).

According to lead author Landon Trost, MD, these findings have significant implications for patient counseling and treatment decision-making. Trost is a urologist at the Male Fertility and Peyronie’s Clinic in Orem, Utah.

The study included a total of 40 men who were randomly assigned 1:1 to receive CCH plus traction (RestoreX) plus sildenafil or penile surgery plus traction plus sildenafil.

Data showed that men who received surgery reported higher subjective rates of length loss (92% vs 46%; P < .001), higher rates of current pain (42% vs 8%; P = .04), and decreased or abnormal sensation (45 vs 27%; P = .03) compared with men in the CCH arm. Other adverse events were similar between both arms. Further, men in both cohorts reported similar willingness to undergo the therapy again (75% to 77%).

“On the physician side, you just want to do what's best for patients, so you look to the data to try to show you which direction is better from a first vs second line [perspective],” Trost added. “It's a big paradigm shift, because for at least the last 60 years, surgery has been the right answer to that question. It looks like with the data from this study, we're saying surgery is probably your backup option of Xiaflex isn't viable.”

REFERENCE

1. Trost L, Savage J, Brearton K, Warner R. Comparison of Collagenase Clostridium Histolyticum Treatment to Surgery in a Protocol for the Management of Peyronie’s Disease: A Randomized Trial – 3 Year Outcomes. Presented at: 26^th Annual Fall Scientific Meeting of the Sexual Medicine Society of North America. October 9-12, 2025. Grapevine, Texas. Abstract 096