Mayo Clinic: Men’s Health Center


Collagenase. The only FDA-approved medication for Peyronie's disease is collagenase clostridium histolyticum (Xiaflex). This therapy has been shown to improve curvature and bothersome symptoms associated with Peyronie's disease. The treatment works by breaking down the buildup of collagen that causes penile curvature. Collagenase appears to be more effective when used in conjunction with "modeling," which is forcible bending of the penis in the opposite direction of the bend and "traction," which is applying force to the penis with a wearable device.

Collagenase treatment consists of a series of injections. Each injection series involves two injections given in the clinic over a period of two to three days, following by a six week break. During this time, you will be encouraged to perform bending ("modeling") and stretching ("traction") of the penis. You will then return to clinic for the next series. A total of four series of injections (8 injections total) will be given over a period of approximately 18 - 20 weeks.

There are alternative medications that may also be injected into the scar tissue such as verapamil. These may be especially useful for men with significant pain or for those who are felt to be poor candidates for collagenase.

Clinician experience is important to provide the best outcomes with treatments for Peyronie's Disease. The Mayo Clinic Men's Health team is one of the busiest centers for treating Peyronie's Disease with Collagenase and other forms of treatment. We are also actively involved in research to further enhance treatment success.

What to Expect From your Visit

What You Need to Know About XIAFLEX Treatment for Peyronie’s Disease: A Patient Guide

XIAFLEX is a prescription medicine used to treat adult men with Peyronie’s disease with an abnormally curved penis and a plaque that can be felt.

What are the serious risks of XIAFLEX treatment? XIAFLEX can cause serious side effects including:

• Penile fracture (corporal rupture) or other serious injury to the penis. While rare, receiving an injection of XIAFLEX may cause damage to the tubes in your penis called the corpora. After treatment with XIAFLEX, one of these tubes may break during an erection. This is called a corporal rupture or penile fracture. In the most severe case this could require surgery to fix the damaged area. Damage to your penis might not get better after corporal rupture. After treatment, blood vessels in your penis may also break, causing blood to collect under the skin (hematoma). This could require a procedure to drain the blood from under the skin.

Do not have sex or any other sexual activity for at least 4 weeks after any XIAFLEX injection, and the pain and swelling have gone away, or until given permission by your healthcare provider.

What symptoms do I need to look for? Call your healthcare provider right away if you have any of the following symptoms of penile fracture or other serious injury to the penis:  

  • A popping sound or sensation in an erect penis
  • Sudden loss of the ability to maintain an erection
  • Severe purple bruising and swelling of your penis
  • Difficulty urinating or blood in the urine
  • Severe pain in your penis

NOTE: These symptoms may occur after XIAFLEX injections and do not necessarily represent a true “penile fracture”. It is very IMPORTANT that you and your local healthcare provider communicate with the Urology team at Mayo Clinic in these circumstances before pursuing any invasive treatment such as surgery at an outside institution. Failure to do so may result in unnecessary surgery that worsens your curvature and carries additional risks.

To contact your Mayo Clinic healthcare provider:

-During regular business hours call the appointment line at (507) 266-3430 and request to IMMEDIATLY speak to your healthcare provider regarding concerns after Xiaflex

-After hours call the Mayo Clinic Operator and ask to speak with the Urology Resident on call at (507) 284-2511

How can I lower the risks associated with XIAFLEX? Before treatment: 

  • Tell your healthcare provider if you have ever had an allergic reaction to XIAFLEX.
  • Tell your healthcare provider about all the medications you take, especially blood thinner medicines such as aspirin, clopidogrel bisulfate (PLAVIX), prasugrel hydrochloride (EFFIENT) or warfarin sodium (COUMADIN). If you are told to stop taking a blood thinner before your XIAFLEX injection, your healthcare provider should tell you when to restart the blood thinner.
  • Tell your healthcare provider if you have any bleeding problems or if you have other medical conditions.

After treatment:

  • Within 24 hours after treatment, your penis may appear bruised and/or swollen and you may have mild-to-moderate penile pain. Ask your healthcare provider if over-the-counter medications are appropriate.
  • Do not engage in sexual activity for at least 4 weeks following any injection of XIAFLEX, and the pain and swelling has gone away, or until given permission by your healthcare provider.
  •  Do the gentle stretching and straightening of your penis at home as shown below.
  • Return to your healthcare provider’s office when directed for further injections

What do I need to do at home? For the 6 weeks after each treatment cycle, you will need to perform the following penis stretching and straightening activity. Your doctor will tell you exactly when to start and how long to continue

Penis Stretches (when penis is not erect)

  • Grasp the tip of your penis with the fingers of one hand and hold the base of your penis with

    the fingers of your other hand (see diagram).

  • Firmly pull your penis away from your body to its full length and hold for 30 seconds

  • Bend the penis firmly in the opposite direction of your curvature and hold for 30 seconds

  • Let go and allow your penis to return to its normal, un-stretched length.

  • Do this stretching exercise each time you urinate, 5-6 times per day and only when the penis is not erect.

  • Your stretching exercises have a large impact on helping to correct the curvature.


Penis Straightening (when penis is erect)

• If you have a spontaneous erection, not related to sexual activity, attempt to straighten your penis by gently bending the shaft in the opposite direction of the curve, but not so forcefully so as to produce significant pain or discomfort.

• Hold the penis in this more straightened position for 30 seconds, then let go.

• Do this straightening only one time each day. If you do not have a spontaneous erection, do not attempt the penis straightening activity.


Did you know?

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