(306) CORPORAL ANEURYSM FOLLOWING CLOSTRIDIUM HISTOLYTICUM INJECTION, A CASE REPORT
Authors: Passarelli R , Islam R , Velez D 
Published: December 2024

Abstract

Introduction
C. histolyticum (Xiaflex®) injection is a commonplace first line treatment for patients with plaque-associated Peyronie’s Disease (PD). This treatment is not without complications – commonly bruising, swelling, hematoma formation, and rarely, corporal rupture. There are no studies that suggest corporal herniation or corporal aneurysm as a potential outcome of Xiaflex injection.

Objective
To describe a patient with a unique sequela following Xiaflex® injection, requiring multiple surgeries, highlight this seldom reported complication, and propose a novel surgical approach.

Methods
A 53-year-old man presented to an outside urologist with a 30-degree leftward curvature. He received Xiaflex® injections on the right side of the corporal body into a presumed Peyronie’s plaque. Despite this, he had persistent curvature with distressing ballooning of the right corpora. He underwent Nesbit plication. The operative note suggests he had a 35-degree curvature to the left and a bulge on the right near where the Xiaflex® had been injected. He underwent multiple “pleating” sutures along the right corpora.

Results
The patient presented at our institution 6 months post-operatively with persistent leftward curvature and bothersome right-sided bulging with palpable sutures from the prior procedure. He underwent penile US with Trimix-induced erection which showed a 20-degree leftward curvature from the mid-shaft, palpable sutures along the right lateral shaft, and a large bulge at the right shaft at prior Xiaflex® injection site. Penile US parameters confirmed normal erectile function. Patient subsequently underwent surgery at our institution. Intra-operatively, the penis was degloved, prior plication sutures were removed, and artificial erection revealed a 3x3.5 cm aneurysmal defect in the right corpora with 35-degree curvature to the left. Bucks fascia and the neurovascular bundle were dissected away from the bulging tunica. Tutoplast pericardium graft was stretched tightly over the bulge and secured to the tunica. A second layer was placed for additional support. This alone corrected the right aneurysmal defect. On the left side, we created multiple fairy cuts, as well as 2 larger incisions through both layers of tunica to correct the curvature. This was covered with Tachosil collagen sponge. Final curvature was &lt;10-degrees. Three months post-operatively, he maintains correction of bulge and is generating firm, straight erections. To our knowledge, this is the first case report of corporal herniation including salvage grafting. One prior case report presents corporal herniation following Xiaflex® injection presenting as a painless soft penile mass during erection at a site different from Xiaflex® injection. Another case reports corporal aneurysm after many priapism aspirations in a patient with sickle cell disease.

Conclusions
There is no standardized treatment for this complication from Xiaflex® injection. Prior to arriving at our institution, the patient underwent a failed surgical procedure that did not address the initial insult of corporal herniation. The procedure we performed improved the patient’s sexual function by eliminating curvature, resolving the patient’s corporal herniation, and restoring his self-confidence. Equipping providers with information about this rare sequela and tools to better resolve it may result in optimal treatment for the patient. Additionally, we hope to bring to light an underreported complication of routine Xiaflex injections for PD.

Disclosure
No.