TOPIC: PMMA reactions and Granulomas

Tell me if I understand this correctly.
For the Kenalog, two types work and one doesn\'t, and is useful to soften the PMMA for being broken up with a cannula, but doesn\'t dissolve it it. This correct restoration?

Resto
I'm absolutely amazed no one who's had hardened PMMA has tried Collagenase, if in theory it dissolves or reduces collagen as you mentioned.
You said it potentially has some bad side effects but are the side effects really as bad as the mess you were left with after they cut it out?
In the UK Collagenase is '1600 / $2k I think anyone with severely hardened PMMA should try this.

But, even if you break down the collagen, the PMMA is still there and it will just come back.

Surely....

The side effects can leave you with blood blisters and hematomas that will leave permanent scarring or require further surgery to correct / drain. One guy took a year to recover:

xiaflexpoison.blogspot.com/

I can\'t believe it is half the price in England. In the USA, the distribution channels are extremely controlled. You can only get it from a hospital pharmacy (like chemo or anesthesia) with a diagnosis of peyronies or dupuytren\'s contracture (for insurance to reimburse). Finding a doc who will inject it is the real question. Are docs more \"out of the box\" in the UK than here? Nobody here would use that. I still have many nodules, btw, but I\'d never risk that stuff. It\'s the same thing that snake venom has which makes the venom travel through your body. Likewise, flesh eating bacteria produces tons of collagenase. You just don\'t want to fuck around with it in your dick. 0.2 mg might be the max.

Hyaluronidase is easy, and you can dilute it and start with a little, have the patient come back and check, etc... but once collagenase is mixed from the powder it comes in, you only have 4 hours before the enzyme is inactive. And, it takes a few weeks to see results, whereas hyaluronidase takes 2-3 days or even hours. Plus, you can refrigerate that stuff for months and add more, if you don\'t see enough results from collagenase, get out your credit card for round 2!

Is it called Xiapex where you are? It\'s Xiaflex here. How did you find out the price? Endo\'s former company was odd about giving the price to anyone. I had a pharmacist in a hospital inquire and it even took him multiple calls to get the price. Looking back... if I had $8000 to spend, I would have had it done it I had no idea that I was going to needd 3-4 surgeries with such large skin incisions...with copays that reached close to that amount anyway. I have a very unnatural and scarred dick now. With xiaflex, it might have just reduced the nodules and been the end of the mess...no scars, no unevenness, no \"why is there all that skin under your dick\" face when the lights aren\'t bright enough (it\'s uneven from the excisions). It\'s a BIG maybe\" though - as it\'s completely out of the box. But hey - hyaluronidase wasn\'t for HA injection dissolution. It was for eye surgery. Then one day, a plastic surgeon tried it for a big HA mistake and it lives on, off-label, as the #1 treatment for that. Not FDA approved at all (for this purpose) - but used daily.

naginati - that\'s the unknown. The idea would be to disperse the clumps of PMMA and perhaps even have the patient come back a few days later to fill the Dick up with CMC or saline to further disperse the beads. You\'d have to be quite a maverick doctor to participate in such a thing. This is again part of why I didn\'t do it. Kenalog and 5fu were known entities and published. Collagenase is scary stuff. Well-studied, but not for this.

I think you were talking about Kenalog-40 and Kenalog-10. One solution is 40% and one is 10%. I can\'t fully recall anymore, but I thought Dr. C only used 40%. I wouldn\'t quote me on that.

The benefit of 40 is that it is much more powerful, but the risk is Atrophy if it leaks too far out of the injection site. You can google and see plenty of pics of Kenalog Atrophy from allergy shots, usually in the butt. In a dense collagen-filled lump from PMMA, he must have had some success with it to continue using it. I can\'t even remember what I had used. 40 or 10 - plus 5fu. Nothing worked anyway.

Yes Pfizer Xiapex it's quite commonly used in England. I remember asking Suks Minhas about it and he had no problem with it and I'd say he's far more conservative than a lot of his US counterparts, has a good reputation also.
I don't doubt it potentially has some bad side effects but I fail to see how the only other option (cutting it out) would be any better. That's assuming you would try less risky options first like steroids and DMSO.

Recklaw, Mr. Minhas had no issue injecting Xiapex into PMMA nodules? Or did you mean he had no issue using it for Peyronie\'s?

How is it obtained in England - I am not really familiar with the NHS but aside from the insurance system in the USA, the distribution channels for the drug are heavily controlled. The doctor needs to register and take an online course for the drug. A hospital pharmacy then needs to order it. Did he say how much he\'d charge for it beyond the base price of the enzyme?

It\'s just interesting to me - 3 years ago I am sort of wishing I could\'ve found someone to try it - but I just never knew what basic Nodule Removal would turn into (when the wounds wouldn\'t close etc).