Private collagenase injection (Xiapex) in London, for Dupuytren’s cord and Peyronie’s plaque.

Collagenase clostridium histolyticum, sold as Xiapex, is an enzyme that dissolves the collagen making up a Dupuytren cord in the hand or a Peyronie’s plaque in the penis. It is injected directly into the cord or plaque under local anaesthetic, softening it so the tissue can be broken or reshaped a day or two later.

Supply of Xiapex in the UK and EU has been intermittent over recent years, with periods where the drug is unavailable. We confirm current availability with our network before quoting a firm price or booking a date — we won’t take a deposit for a treatment we can’t deliver.

Both are minimally invasive alternatives to open surgery for Dupuytren’s. Needle fasciotomy uses a needle tip to cut the cord directly and requires no drug; collagenase uses an enzyme to dissolve the cord and needs a recall visit for manipulation. Fasciotomy tends to be cheaper and quicker to arrange; collagenase can suit thicker, well-defined cords.

Open fasciectomy — surgical removal of the diseased fascia — remains the gold standard for advanced or recurrent Dupuytren’s, particularly with PIP joint involvement. It has a longer recovery but lower short-term recurrence than collagenase or needle fasciotomy. We arrange fasciectomy where it is the better option.

For stable-phase Peyronie’s with a curvature between 30° and 90°, collagenase is injected into the plaque in a course of four injections over roughly 12 weeks, with penile modelling by the andrologist between doses. It aims to reduce curvature and improve function — outcomes vary and are discussed openly.

The area is numbed with local anaesthetic first. Most people describe pressure and pushing rather than sharp pain. Bruising and swelling at the injection site over the following days are more noticeable than the injection itself.

For Dupuytren, you return 24–48 hours after the injection. The surgeon numbs the finger again if needed and extends it firmly — the softened cord snaps, and the finger straightens. For Peyronie’s, the andrologist performs modelling of the plaque between injections in the course.

A single-cord Dupuytren injection is typically £1,800–£3,500, multiple cords £2,500–£4,800, and a full Peyronie’s course £6,000–£12,000. Adding hand therapy or splinting is £2,000–£3,900. We confirm a firm figure — dependent on drug availability — within one working day.

Recurrence after collagenase in Dupuytren’s is meaningful — a proportion of patients see the contracture return within a few years, and rates vary by joint (MCP tends to do better than PIP). Recurrence is higher than after open fasciectomy but comparable to needle fasciotomy. Splinting and hand therapy help.

Sudden severe pain, a change in the shape of the finger or penis, rapidly spreading bruising, a fever, or an inability to move the finger needs same-day review by the treating surgeon or andrologist — cord or plaque rupture, though rare, must be caught quickly.