Xiaflex ultrasound or MRI during injections

[Turin099]

Can anyone tell me if your xiaflex injections are being done while the doctor is using an ultrasound device to locate plaque? I'm confused if the majority of men on this site have had an ultrasound or MRI on their penis done so the doctor has a baseline for the plaque. Does the doctor use this when determining where to place xiaflex injections? I've also read about the use of ultrasound prior to and while performing injections. I've been approved for injections by my insurer but I'm really trying to ascertain the best methods before having it done. Any responses would be great but I would really appreciate a response from Dr Lue or Dr Gerald's patients.  

[Mending the Bend]

Turin099,

I'm not a patient of Dr. Lue or Dr. Gerald, but I can tell you that the procedure for injecting Xiaflex consists of the doctor palpating (feeling) the plaque and injecting into it without the aid of imaging devices. Peyronie's Disease plaques offer significantly more resistance to the injecting needle than does the normal surrounding tissue, so the doctor can tell when he is in the right place.

The protocol also calls for the injections to be done at the location of maximum deformity, so either you or your doctor may place a mark on your penis at the point of greatest curvature while erect. You can also measure the point by the distance below your glans.

Honestly, I was (and still am) a little concerned about the wonkiness of how and where the injections are given. The thing is, so far it's working quite well for me - with two injections done so far.

I do believe that different sizes and types of plaques probably would benefit from different injection locations. For example, if you have a long, thin plaque running the length of your penis, you might want injections spread out over the length to break it up in pieces. Xiaflex is still in its very early stages of clinical treatment, so I suspect in a few years they will know a lot more.

[Turin099]

Thank you so much for the input. I also feel it is a bit wonky. I recently received a cortisone shot in my elbow for tendenosis. The doctor used ultrasound imaging to determine precisely where the scar tissue was located.  It just seems crude that a doctor will inject something as important and delicate as my penis w/o some type of imaging.  

[Cantstopme]

Mending,

I'm also a bit concerned (perplexed, really) about the wonkiness of the injection placement. My penis was marked at the point of curvature while erect. However, once flaccid, the mark on the skin was nowhere near where the plaque is due to the stretching of the skin during erection. But, having gone through several Verapamil injections, my Dr. is well aware of where my plaque is and had no trouble hitting the mark and, therefore, I think that's why I had very little bruising and swelling.

Because my plaque is so well defined and he has been there before, I questioned him about the need for the erection and marking in the first place. He agreed it seemed unnecessary in my case but said it was how he was trained and he had to adhere to the protocol. I think its basically a CYA thing.  

[Mending the Bend]

Turin099,

Doctors can feel the plaque between their fingers while they're injecting the needle in your penis, and they know when they're in there by tactile pressure. Getting the shot *somewhere* in the plaque hasn't been so much my concern. Rather, as Cantstopme points out:

My penis was marked at the point of curvature while erect. However, once flaccid, the mark on the skin was nowhere near where the plaque is due to the stretching of the skin during erection.

This is what bothered me as well. The explanation is that the doctor fully stretches out your flaccid penis before injecting the Xiaflex, so that the marked skin is adjacent to the tunica/plaque in the same location as when you're erect.

But it still feels a little like guesswork to me.