(120) A Survey of Exposure to the Use of Xiaflex for the Treatment of Peyronie’s Disease Among United States Urology Residency Programs
Authors: Loloi J , Schuppe K , Reddy R , Rahman F , Bernstein A , Reddy P , Kulkarni N , Masterson T , Ramasamy R 
Published: February 2024

Abstract

Introduction
Xiaflex (Collagenase Clostridium Histolyticum) is an FDA-approved treatment for patients with Peyronie’s Disease. However, despite its approval and widespread implementation in clinical practice, there is concern that urologists in training are offered minimal exposure to its use.

Objective
Thus, the purpose of this study was to evaluate the exposure of urology residents to Peyronie’s Disease and its management, particularly Xiaflex.

Methods
A six-question Google Forms survey regarding exposure of residents to Peyronie’s Disease and the Use of Xiaflex was created. The survey was disseminated through email to urology residency program directors, chief residents, or andrology-focused faculty.

Results
Overall, 47 institutional responses were received, eliciting a response rate of approximately 34%. At 45 institutions (96%), residents receive training in directly evaluating and caring for patients with Peyronie’s disease. Of these, in 36 institutions the training is led by an academic faculty who is fellowship trained in sexual medicine. At 46 institutions (98%), residents receive training in observing and/or performing surgical procedures such as plication, grafting, and penile implants for Peyronie’s disease. With regards to surgical treatment, residents are trained by an academic faculty who is fellowship trained in sexual medicine at 35 programs. Conversely, residents at only 31 institutions (66%) receive observational or procedural training for non-surgical management of Peyronie’s disease, specifically Xiaflex. Residents receive non-surgical training by an academic faculty who is fellowship trained in sexual medicine at 25 institutions and an academic faculty who is not trained in sexual medicine at 6 institutions. When categorizing based on AUA section: 3 out of 4 Mid-Atlantic programs (75%), 3 out of 4 New England programs (75%), 2 out of 8 New York programs (25%), the 1 Northeastern program (100%), all 11 North Central programs (100%), 5 out of 6 South Central programs (83.33%), 5 out of 6 Southeastern programs (83.33%), and 3 out of 6 Western programs (50%) reported residency exposure to the use of Xiaflex.

Conclusions
Urology residents receive broad exposure to the management of Peyronie’s Disease, particularly its surgical treatment. However, there exists a glaring disparity in residency exposure to Xiaflex, which represents the sole FDA-approved medical management for Peyronie’s Disease. To our knowledge, we present the first study evaluating resident exposure to Xiaflex in the treatment of PD. We believe it is important for United States residency programs to ensure that their trainees are educated on the use of this treatment option. A broader incorporation of training of Xiaflex among urology residents may increase the number of providers who are comfortable and competent with providing this level of care to a potentially vulnerable patient population. Further research is warranted to elucidate why this discrepancy exists and how programs can provide residents with further exposure to the use of Xiaflex in patients with Peyronie’s Disease.

Disclosure
No.