V04-07: How to improve your Xiapex results in Peyronie’s disease: The Percutaneous Needle Tunnelling (PNT) technique. Step-by-step surgical video
Intralesional injection of collagenase from Clostridium histolyticum (CCH; Xiapex®) has demonstrated an improvement in curvature in selected patients, sparing many of them from surgery. A combination of two techniques for the treatment of Peyronie’s disease (PD): percutaneous needle tunnelling (PNT) on the plaque and subsequent administration of CCH has been used in our centre since December 2016. We believe this combination could lead to a more cost-effective treatment. In this video we will show how this technique is performed in our centre.
Our modified IMPRESS-based protocol consisted of two collagenase injections, at one-week intervals, followed by penile modelling. Patients used penile traction therapy, tadalafil and pentoxifylline for the next two months. Before the injection of Xiapex®, PNT was performed by creating multiple tunnels or holes along the entire plaque using a 25G needle.
Thirty-two patients with stable disease (curvature <90°) were treated. We saw an improvement in curvature degrees of 17.5±5.5º (-36%). No clinically significant increase in penis length was observed. The value of all PDQ domains, as well as IIEF-5 and EHS improved at 6 months of treatment. The treatment would be recommended by 84,0% and 96,9% of the patients observed improvement after treatment. The main complications observed were ecchymosis, bruising and penile pain. No corporeal rupture was observed. Comparing our results with those previously reported, we observed that the improvement per injection was greater in our protocol with PNT.</p>
This novel treatment with CCH using our modified protocol in combination with PNT seems to be safe and effective for treating PD. It provides an alternative approach in the treatment of this disease and may be more cost-effective.