{"id":121,"date":"2014-04-15T04:43:03","date_gmt":"2014-04-15T04:43:03","guid":{"rendered":"https:\/\/www.newyorkurologyspecialists.com\/peyronies\/?page_id=121"},"modified":"2020-06-04T04:18:56","modified_gmt":"2020-06-04T04:18:56","slug":"patient-selection","status":"publish","type":"page","link":"https:\/\/www.newyorkurologyspecialists.com\/peyronies\/xiaflex\/patient-selection\/","title":{"rendered":"Xiaflex – Patient Selection"},"content":{"rendered":"

Xiaflex – Patient Selection Criteria<\/h1>\n

by Alex Shteynshlyuger MD<\/a><\/strong><\/p>\n

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If you have any questions, to schedule a consultation<\/a>, please contact us<\/a> or call\/text: <\/strong>1-646-663-4050<\/span><\/a>.<\/strong><\/p>\n

We have excellent reviews from patients <\/a><\/strong>and their partners.  Information for out-of-state and international patients<\/a>.  <\/strong><\/span><\/p>\n

We offer affordable prices<\/a> with or without insurance.<\/strong><\/span><\/p>\n

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At New York Urology Specialists<\/a> our goal is to match the right patient with the right treatment. <\/strong><\/p>\n

While Xiaflex<\/strong> has been shown to be an effective treatment for Peyronie’s disease<\/a> not everyone is an ideal candidate for Xiaflex<\/strong>.  The goal is to maximize the chances of success<\/strong>, in particular given the cost of Xiaflex, as well as to minimize the risks of treatment given the known side effects of treatment with Xiaflex.<\/p>\n

Based on the published studies current criteria for Xiaflex administration<\/strong> at New York Urology Specialists are listed below.<\/p>\n

Xiaflex as a Treatment Option: Criteria Used at New York Urology Specialists<\/h1>\n

\"Peyronies<\/a>#1.  Symptomatic disease<\/strong> that is causing 1 or more of the following: penile pain<\/a><\/strong>, difficulty with intercourse, curvature, relationship difficulties as a result of the curvature<\/a><\/strong>.<\/p>\n

#2.  Good Erectile Function<\/strong>:   A straight penis is not very useful if it’s not sufficiently hard for sex.  A good erection<\/strong> is an important criterion for the use of Xiaflex.<\/p>\n

Men with erectile dysfunction<\/strong><\/a> that is responsive to medical treatment with oral medications such as Viagra or Cialis or Levitra<\/strong><\/a>, intraurethral medications such as Muse, or that can be effectively treated penile injections<\/a><\/strong> with vasoactive medications such as Trimix are also good candidates for Xiaflex.<\/p>\n

Patients with severe erectile dysfunction<\/strong> for whom medications do not work will not be well served with Xiaflex with some exceptions.  Men with severe ED are better served with penile prosthesis<\/a><\/strong> along with excision of the Peyronie’s plaque when necessary.<\/p>\n

#3. Plaque Location<\/strong>.  The curvature must be up or to the side (dorsal curvature<\/a><\/strong>).  Peyronie’s plaque <\/a>cannot involve the urethra or be very close to the urethra which occurs in 10-20% of men.  This is due to the risk of injury to the urethra with the potential for significant complications if Xiaflex is injected into the urethral wall.  Treatment of ventral plaque is possible but will not be covered by health insurance.<\/p>\n

#4. Curvature<\/strong>. The curvature must be at least 30\u00b0<\/strong>.   Currently, most insurances use criteria based on the fact that most men with curvature less than 30 degrees are minimally symptomatic.   <\/span><\/p>\n

#5. Peyronie’s plaque. <\/strong> Peyronie’s plaque must be palpable<\/strong> and should be visualizable on penile ultrasound<\/a>.  Most symptomatic plaques are large enough to be palpable.  This is a necessary condition in order to administer the medication.<\/p>\n

#6. Plaque Calcifications<\/strong>. Ideal candidates for Xiaflex administration are men with non-calcified or minimally-calcified Peyronie’s plaque<\/strong>.  The mechanism of action of Xiaflex is to break the connections between abnormally healed proteins.  Calcifications create a solid structure that is thought to have a poorer response to a medication such as Xiaflex.  Based on the mechanism of action of Xiaflex, we believe that the success of Xiaflex decreases as the degree of calcification of the plaque increases.<\/p>\n

#7.  Medical Requirements<\/strong>.  Patients cannot take blood-thinners, have an active infection, or be immuno-compromised when getting Xiaflex.<\/p>\n

#8.  Patients must understand that the treatment cycle can take 6 months to complete<\/strong>.  The patient must understand that most men do not experience complete resolution of curvature.  Typically Xiaflex leads to improvement of curvature<\/strong>.  Many men may experience no significant benefit from treatment with Xiaflex.<\/p>\n

The patient selection criteria are used by insurance companies to determine whether to cover the cost of Xiaflex<\/a><\/strong> treatment. Deviation from these guidelines may result in non-coverage of Xiaflex by health plans.<\/p>\n

Did you know?<\/strong>  <\/span>Dr. Shteynshlyuger has performed over 1,000 penile surgeries<\/strong> including penile implants, correction of Peyronie’s disease, circumcisions, circumcision revisions, frenuloplasty, and congenital penile curvature.  He performs 150-200 penile surgeries a year.<\/p>\n