{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:50:03Z","timestamp":1773017403230,"version":"3.50.1"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["jsm.jsexmed.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,7,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Intralesional collagenase such as Xiaflex (ILX) has become a standard treatment for Peyronie\u2019s disease (PD). Many robust studies have demonstrated its clear efficacy in the treatment algorithm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To examine predictors of the patient decision to pursue ILX in PD patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study included PD patients (i) with stable disease (ii) who had doppler duplex ultrasonography (DUS) at least 6 months prior to analysis date and (iii) did not choose an operation. All patients received a standard discussion regarding treatment options, specifically, observation, ILX and penile reconstructive surgery (plication, plaque incision and grafting, implant surgery). Patients who opted to use ILX were compared to those who opted against it. Comorbidity, demographic and PD characteristics were recorded at the initial PD visit. All patients completed three validated questionnaires including the PD questionnaire (PDQ), Self-Esteem and Relationship (SEAR) questionnaire and a depression questionnaire (CES-D). Logistic regression was used to determine predictors of ILX use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes<\/jats:title><jats:p>Predictors of ILX utilization.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Four hundred and fifty stable PD men had DUS completed 6 months before to allow sufficient time for treatment decision. Of these, 111 (24.7%) patients had ILX treatment and 339 (75.3%) did not. Mean age, relationship status and pain occurrence were similar between groups, but ILX patients had less bother defined as PDQ \u2265 9 (46.8% vs 53.7%, P = .02). ILX patients had more complex curves (79.3% vs 47.8%, P &amp;lt; .01) and more severe instability (32.4% vs 15.3%, P = .01). ILX patients also had higher PDQ domain scores (Psychological 11.5 \u00b1 6.4 vs 7.5 \u00b1 6.2, P &amp;lt; .01; Pain 6.2 \u00b1 6.0 vs 4.3 \u00b1 5.6, P = .02; and Bother 9.8 \u00b1 4.7 vs 6.6 \u00b1 4.8, P &amp;lt; .01). On univariable statistics, significant bother (OR 2.41, 95% CI 1.36\u20134.28, P&amp;lt;0.01), complex curvature (OR 4.18, 95%CI 2.52\u20136.93, P &amp;lt; .01), moderate and\/or severe instability (OR 1.98, 95%CI 1.18\u20133.30, P &amp;lt; .01) and PDQ-Bother scores (OR 1.15, 95%CI 1.08\u20131.22 P &amp;lt; .01) predicted ILX use. On multivariable analysis, instability (OR 2.58, 95%CI 1.02\u20136.57, P = .05) and significant bother (OR 1.23, 95%CI 1.04\u20131.45, P = .01) predicted ILX use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Implications<\/jats:title><jats:p>Educates providers as to which patients are more likely to choose ILX.<\/jats:p><\/jats:sec><jats:sec><jats:title>Strengths &amp; Limitations<\/jats:title><jats:p>Our study has a large sample size and all patients received the same standardized treatment discussion. Our study is limited by the absence of insurance data on all patients, and its retrospective single center design.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>ILX was chosen by the minority of stable PD patients. While moderate to severe instability and significant bother is predictive of ILX use, other demographic factors including relationship status, sexual orientation or pain were not.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.jsxm.2021.05.006","type":"journal-article","created":{"date-parts":[[2021,7,3]],"date-time":"2021-07-03T06:49:08Z","timestamp":1625294948000},"page":"1258-1264","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":3,"title":["Predictors of Pursuing Intralesional Xiaflex in Peyronie\u2019s Disease Patients"],"prefix":"10.1093","volume":"18","author":[{"given":"Nahid","family":"Punjani","sequence":"first","affiliation":[{"name":"Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center , NY, NY , USA"},{"name":"Department of Urology, Center for Male Reproductive Medicine and Microsurgery, Weill Cornell Medicine of Cornell University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Nascimento","sequence":"additional","affiliation":[{"name":"Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center , NY, NY , USA"},{"name":"Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas, Urology, Sao Paulo , Sao Paulo, BR"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolyn","family":"Salter","sequence":"additional","affiliation":[{"name":"Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center , NY, NY , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose","family":"Flores","sequence":"additional","affiliation":[{"name":"Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center , NY, NY , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo","family":"Miranda","sequence":"additional","affiliation":[{"name":"Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center , NY, NY , USA"},{"name":"Universidade Federal do Ceara, Division of Urology , Fortaleza, BR"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean","family":"Terrier","sequence":"additional","affiliation":[{"name":"Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center , NY, NY , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hisanori","family":"Taniguchi","sequence":"additional","affiliation":[{"name":"Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center , NY, NY , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center , NY, NY , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John P.","family":"Mulhall","sequence":"additional","affiliation":[{"name":"Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center , NY, NY , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,7,3]]},"reference":[{"key":"2023041407032130100_","first-page":"61","article-title":"A review of the epidemiology and treatment of Peyronie\u2019s disease","volume":"8","author":"Ostrowski","year":"2016","journal-title":"Res Rep Urol"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.esxm.2018.07.003","article-title":"Beyond curvature: Prevalence and characteristics of penile volume-loss deformities in men with Peyronie\u2019s disease","volume":"6","author":"Margolin","year":"2018","journal-title":"Sex Med"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0150157","article-title":"The prevalence of Peyronie\u2019s disease in the United States: A population-based study","volume":"11","author":"Stuntz","year":"2016","journal-title":"PLoS One"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1111\/bju.13096","article-title":"Clinical efficacy of collagenase clostridium histolyticum in the treatment of Peyronie\u2019s disease by subgroup: Results from two large, double-blind, randomized, placebo-controlled, phase III studies","volume":"116","author":"Lipshultz","year":"2015","journal-title":"BJU Int"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1046\/j.1464-4096.2001.02436.x","article-title":"The prevalence of Peyronie\u2019s disease: Results of a large survey","volume":"88","author":"Schwarzer","year":"2001","journal-title":"BJU Int"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","DOI":"10.1155\/2011\/282503","article-title":"A population-based study of Peyronie\u2019s disease: Prevalence and treatment patterns in the United States","volume":"2011","author":"Dibenedetti","year":"2011","journal-title":"Adv Urol"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1111\/j.1743-6109.2012.02999.x","article-title":"Psychological impact of Peyronie\u2019s disease: A review","volume":"10","author":"Nelson","year":"2013","journal-title":"J Sex Med"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.sxmr.2016.07.004","article-title":"Review of management options for patients with atypical Peyronie\u2019s disease","volume":"5","author":"Yafi","year":"2017","journal-title":"Sex Med Rev"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1016\/S0022-5347(17)35291-6","article-title":"Intralesional verapamil injection for the treatment of Peyronie\u2019s disease","volume":"151","author":"Levine","year":"1994","journal-title":"J Urol"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/S0022-5347(06)00517-9","article-title":"Single-blind, multicenter, placebo controlled, parallel study to assess the safety and efficacy of intralesional interferon alpha-2B for minimally invasive treatment for Peyronie\u2019s disease","volume":"176","author":"Hellstrom","year":"2006","journal-title":"J Urol"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1016\/S0022-5347(17)67169-6","article-title":"Peyronie\u2019s disease: Results with dermo-jet injection of dexamethasone","volume":"114","author":"Winter","year":"1975","journal-title":"J Urol"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1177\/1756287213509849","article-title":"Intralesional collagenase in the treatment of Peyronie\u2019s disease","volume":"6","author":"Honig","year":"2014","journal-title":"Ther Adv Urol"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.juro.2015.05.098","article-title":"Peyronie\u2019s disease: AUA guideline","volume":"194","author":"Nehra","year":"2015","journal-title":"J Urol"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/S0022-5347(17)35998-0","article-title":"Collagenase versus placebo in the treatment of Peyronie\u2019s disease: A double-blind study","volume":"149","author":"Gelbard","year":"1993","journal-title":"J Urol"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.juro.2013.01.087","article-title":"Clinical efficacy, safety and tolerability of collagenase clostridium histolyticum for the treatment of peyronie disease in 2 large double-blind, randomized, placebo controlled phase 3 studies","volume":"190","author":"Gelbard","year":"2013","journal-title":"J Urol"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1111\/jsm.12769","article-title":"The test-retest reliability of the Peyronie\u2019s disease questionnaire","volume":"12","author":"Coyne","year":"2015","journal-title":"J Sex Med"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"e58067","DOI":"10.1371\/journal.pone.0058067","article-title":"The center for epidemiologic studies depression scale: A review with a theoretical and empirical examination of item content and factor structure","volume":"8","author":"Carleton","year":"2013","journal-title":"PLoS One"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/sj.ijir.3901095","article-title":"Development and validation of the Self-Esteem And Relationship (SEAR) questionnaire in erectile dysfunction","volume":"16","author":"Cappelleri","year":"2004","journal-title":"Int J Impot Res"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1111\/j.1743-6109.2008.00895.x","article-title":"The chronology of depression and distress in men with Peyronie\u2019s disease","volume":"5","author":"Nelson","year":"2008","journal-title":"J Sex Med"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1111\/j.1743-6109.2008.00949.x","article-title":"Risk factors for emotional and relationship problems in Peyronie\u2019s disease","volume":"5","author":"Smith","year":"2008","journal-title":"J Sex Med"},{"key":"2023041407032130100_","article-title":"Long-term safety and curvature deformity characterization in patients previously treated with collagenase clostridium histolyticum for Peyronie\u2019s disease","author":"Goldstein","year":"2020","journal-title":"J Urol"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.urology.2016.04.049","article-title":"Peyronie\u2019s disease and injectable collagenase clostridium histolyticum: Safety, efficacy, and improvements in subjective symptoms","volume":"94","author":"Yang","year":"2016","journal-title":"Urology"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1097\/JU.0000000000000032","article-title":"Intralesional collagenase clostridium histolyticum causes meaningful improvement in men with Peyronie\u2019s disease: Results of a multi-institutional analysis","volume":"201","author":"Hellstrom","year":"2019","journal-title":"J Urol"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1016\/j.jsxm.2018.08.012","article-title":"Sildenafil 25 mg ODT + collagenase clostridium hystoliticum vs collagenase clostridium hystoliticum alone for the management of Peyronie\u2019s disease: A matched-pair comparison analysis","volume":"15","author":"Cocci","year":"2018","journal-title":"J Sex Med"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1038\/s41443-018-0063-1","article-title":"Limited success with clostridium collagenase histolyticum following FDA approval for the treatment of Peyronie\u2019s disease","volume":"31","author":"Tsambarlis","year":"2019","journal-title":"Int J Impot Res"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.urology.2018.06.049","article-title":"Multi-institutional prospective analysis of intralesional injection of collagenase clostridium histolyticum, tunical plication, and partial plaque excision and grafting for the management of Peyronie\u2019s disease","volume":"120","author":"Yafi","year":"2018","journal-title":"Urology"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1111\/andr.12497","article-title":"Collagenase clostridium histolyticum for the treatment of Peyronie\u2019s disease: A prospective Italian multicentric study","volume":"6","author":"Capece","year":"2018","journal-title":"Andrology"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.urology.2017.01.054","article-title":"Clinical experience with penile traction therapy among men undergoing collagenase clostridium histolyticum for Peyronie disease","volume":"104","author":"Ziegelmann","year":"2017","journal-title":"Urology"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1016\/j.jsxm.2017.08.015","article-title":"Treatment of Peyronie\u2019s disease with collagenase clostridium histolyticum and vacuum therapy: A randomized, open-label pilot study","volume":"14","author":"Ralph","year":"2017","journal-title":"J Sex Med"},{"key":"2023041407032130100_","first-page":"474","article-title":"Injection therapy for Peyronie\u2019s disease: Pearls of wisdom","volume":"4","author":"Brant","year":"2015","journal-title":"Transl Androl Urol"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"334","DOI":"10.21037\/tau.2016.03.16","article-title":"Grafting techniques for Peyronie\u2019s disease","volume":"5","author":"Hatzichristodoulou","year":"2016","journal-title":"Transl Androl Urol"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1111\/j.1743-6109.2010.02102.x","article-title":"Five-year follow-up of Peyronie\u2019s graft surgery: Outcomes and patient satisfaction","volume":"8","author":"Chung","year":"2011","journal-title":"J Sex Med"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1038\/aja.2012.92","article-title":"Surgery for Peyronie\u2019s disease","volume":"15","author":"Levine","year":"2013","journal-title":"Asian J Androl"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.urology.2015.04.047","article-title":"Self-report and clinical response to Peyronie\u2019s disease treatment: Peyronie\u2019s disease questionnaire results from 2 large double-blind, randomized, placebo-controlled phase 3 studies","volume":"86","author":"Hellstrom","year":"2015","journal-title":"Urology"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/j.juro.2013.01.090","article-title":"Bother and distress associated with Peyronie\u2019s disease: Validation of the Peyronie\u2019s disease questionnaire","volume":"190","author":"Hellstrom","year":"2013","journal-title":"J Urol"},{"key":"2023041407032130100_","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1136\/bmj.318.7181.452","article-title":"ABC of sexual health: Homosexual men and women","volume":"318","author":"Bell","year":"1999","journal-title":"BMJ"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609521005105?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609521005105?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/18\/7\/1258\/49887564\/jsm_18_7_1258.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/18\/7\/1258\/49887564\/jsm_18_7_1258.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,5]],"date-time":"2023-11-05T16:24:15Z","timestamp":1699201455000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/18\/7\/1258\/6956016"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,1]]},"references-count":36,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7,3]]},"published-print":{"date-parts":[[2021,7,1]]}},"URL":"https:\/\/doi.org\/10.1016\/j.jsxm.2021.05.006","relation":{},"ISSN":["1743-6109","1743-6095"],"issn-type":[{"value":"1743-6109","type":"electronic"},{"value":"1743-6095","type":"print"}],"subject":[],"published-other":{"date-parts":[[2021,7]]},"published":{"date-parts":[[2021,7,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Predictors of Pursuing Intralesional Xiaflex in Peyronie's Disease Patients","name":"articletitle","label":"Article Title"},{"value":"The Journal of Sexual Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jsxm.2021.05.006","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Copyright \u00a9 2021, International Society of Sexual Medicine. Published by Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}