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Bu Z, Xiang T, Lei Z, Yang Q, Wu Y, Ye E, He B, Zheng M, Ali K. A new option for the treatment of condyloma acuminatum in the male urethra: Multimodal ultrasound image-guided scraping and photodynamic therapy (USP). Photodiagnosis Photodyn Ther 2022; 39:102985. [PMID: 35753674 DOI: 10.1016/j.pdpdt.2022.102985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/09/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Condyloma acuminatum (CA) is a sexually transmitted disease with a high recurrence rate due to the rapid replication of human papillomavirus (HPV) and its subtle immune escape mechanism, which makes the diagnosis and treatment of CA in the male urethra particularly difficult. This study aims to evaluate the efficacy of comprehensive treatments for male urethral CA after accurate localization of warts under ultrasound guidance. METHODS The study included 15 men with intraurethral CA. Before treatment, the urethra was examined by ultrasonography and HPV-PCR. After examination of the invisible urethral warts, wart curettage (penetrating operation with a special stainless steel medical curettage tool) combined with ALA-PDT was used for treatment. The ultrasound and HPV load were reviewed 1 week after treatment, and again at 1, 3, and 6 months after treatment. RESULTS All patients achieved satisfactory results 1 week after the last treatment. The viral load of human papilloma was significantly reduced or turned negative, ultrasound imaging exploration showed no neoplasm in the urethra, and no obvious intraoperative or postoperative complications were observed. The side effects in patients included a mild burning or tingling sensation confined to the treated area. After a 6 month follow-up period, only 2 patient relapsed. CONCLUSION The combined diagnosis and treatment of CA in the male urethra under the guidance of multi-mode ultrasound imaging is an effective, economical, safe, and well-tolerated treatment method.
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Affiliation(s)
- Zhangyu Bu
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, hangzhou,310006,China.
| | - Tingkai Xiang
- The Fourth School of Medicine Affiliated to Zhejiang Chinese Medical University,hangzhou, 310053,China
| | - Zhikai Lei
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine,hangzhou, 310006,China
| | - QingYun Yang
- The Fourth School of Medicine Affiliated to Zhejiang Chinese Medical University,hangzhou, 310053,China
| | - YangFan Wu
- The Fourth School of Medicine Affiliated to Zhejiang Chinese Medical University,hangzhou, 310053,China
| | - EnYi Ye
- The Fourth School of Medicine Affiliated to Zhejiang Chinese Medical University,hangzhou, 310053,China
| | - BeiLei He
- The Fourth School of Medicine Affiliated to Zhejiang Chinese Medical University,hangzhou, 310053,China
| | - Min Zheng
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine,hangzhou,310001
| | - Kamran Ali
- Department of Dermatology,International Education College of Zhejiang Chinese Medical University,hangzhou,310053,China
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Mestrovic T, Sviben M, Zember S, Drenjancevic D. Topical medication as an initial therapeutic option for protruding and non-protruding condylomata acuminata of the distal urethra. BMJ Case Rep 2021; 14:e243618. [PMID: 34548297 PMCID: PMC8458332 DOI: 10.1136/bcr-2021-243618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 11/04/2022] Open
Abstract
Genital warts (also known as condylomata acuminata) caused by the human papillomavirus (HPV) represent one of the most common sexually transmitted infections. Although they are usually found in the outer genital region, a small proportion of men can present with (often unrecognised) intraurethral warts, generally limited to the distal urethra and urethral meatus. This poses a treatment challenge not adequately addressed by the current guidelines. Here, we present two cases of low-risk HPV-positive patients with protruding and non-protruding condylomata acuminata of the distal urethra, which were treated successfully by using two different topical regimens (ie, a combination of policresulen and imiquimod for one patient and 5-fluorouracil monotherapy for the other). Although this type of management results in lower rates of tissue destruction and complications and may be given preference as an initial therapeutic option, additional prospective comparative clinical studies are needed to elucidate its potential in similar cases.
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Affiliation(s)
- Tomislav Mestrovic
- Clinical Microbiology and Parasitology Unit, Dr. Zora Profozic Polyclinic, Zagreb, Croatia
- University Centre Varazdin, University North, Varazdin, Croatia
| | - Mario Sviben
- Department of Medical Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia
- Microbiology Service, Croatian National Institute of Public Health, Zagreb, Croatia
| | - Sanja Zember
- Department for Urogenital Infections, University Hospital for Infectious Diseases 'Dr. Fran Mihaljević', Zagreb, Croatia
| | - Domagoj Drenjancevic
- Clinical Microbiology Department, University Hospital Centre Osijek, Osijek, Croatia
- Department of Microbiology and Parasitology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Chang R, Xu C, Liu Y, Liu J, Liu W, Jiang F, Zhang S. 5-aminolevulinic acid photodynamic therapy and holmium laser treatment for intraurethral condylomata acuminata in a renal transplant patient. Photodiagnosis Photodyn Ther 2021; 36:102496. [PMID: 34428575 DOI: 10.1016/j.pdpdt.2021.102496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/20/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022]
Abstract
Condylomata acuminata (CA) caused by human papillomavirus, often involves the external genitalia, perianal skin, and other moist mucous membranes. Urethral involvement is uncommon and little recognized, and usually limited to the distal 3 cm of the meatus. It is difficult to treat CA involving the urethra because of the anatomical location, risk of complications and recurrence. One effective method for the treatment of CA located at the urinary meatus is 5-aminolevulinic acid photodynamic therapy (ALA-PDT). However, experience of using this method for the treatment of whole urethral CA is still very limited. Herein, we treated a whole urethral CA successfully with photodynamic and holmium laser therapies. The case of a 25-year-old patient who underwent kidney transplant effected by intraurethral CA is presented and discussed. Catheter implantation and (or) immunosuppression treatment increases the risk of urethral condyloma acuminatum. The ALA-PDT is a safe, straightforward, effective, and well-tolerated treatment procedure for intraurethral CA. ALA-PDT combined with holmium laser treatment can successfully treat kidney transplant patients with intraurethral CA.
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Affiliation(s)
- Ruixue Chang
- Department of Dermatology and Venereology, The First Affiliated Hospital of USTC
| | - Congyun Xu
- Department of Urological Surgery, The First Affiliated Hospital of USTC, Hefei, Anhui, China
| | - Yixun Liu
- Department of Urological Surgery, The First Affiliated Hospital of USTC, Hefei, Anhui, China
| | - Jinli Liu
- Department of Dermatology and Venereology, The First Affiliated Hospital of USTC
| | - Wei Liu
- Department of Dermatology and Venereology, The First Affiliated Hospital of USTC
| | - Faxing Jiang
- Department of Dermatology and Venereology, The First Affiliated Hospital of USTC,.
| | - Siping Zhang
- Department of Dermatology and Venereology, The First Affiliated Hospital of USTC
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Kim CJ, Campbell SP, Allkanjari A, Lentz AC. Update on the Medical and Surgical Management of Urethral Condyloma. Sex Med Rev 2021; 10:240-254. [PMID: 33752995 DOI: 10.1016/j.sxmr.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/23/2021] [Accepted: 01/24/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Condyloma acuminata (CA) of the urethra presents a management challenge due to high recurrence rates, difficulty in accessing urethral lesions, risk of stricture formation, and potential for sexual dysfunction. While standard treatment modalities are acceptable for some external genital condyloma, they are not always feasible or appropriate for urethral lesions. OBJECTIVES We sought to review the literature on epidemiology, presentation, diagnosis and treatment of urothelial CA with a focus on surgical treatment options. METHODS We performed a comprehensive literature search of PubMed to identify all studies pertaining to urethral CA through November 2020. RESULTS Urethral CA is a relatively rare, but challenging disease to manage with a considerable amount of treatment side effects and downstream morbidity associated. In our comprehensive review we have found a wide selection of treatment modalities ranging from minimally invasive strategies to surgical reconstructive techniques. Proper follow-up to monitor for disease recurrence at the 3-4 month mark is appropriate and will determine subsequent treatment strategies as needed. Future studies and treatment directions include novel drug delivery models to optimize minimally invasive topical drug efficacy. CONCLUSION Treatment of urethral CA should be approached in a step-wise fashion. Medical therapy would be an appropriate option for asymptomatic or minimally symptomatic patients with small lesions who desire to avoid any interventions. If patient is symptomatic, has extensive disease burden or has failed medical therapy intervention should be considered with options including PDT, laser ablation or surgical excision with or without urethral reconstruction. Appropriate selection depends on patient characteristics and preferences along with prior treatment history. Kim CJ, Campbell SP, Allkanjari A, et al. Update on the Medical and Surgical Management of Urethral Condyloma. Sex Med Rev 2021;xxx:xxx-xxx.
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Affiliation(s)
- Christopher J Kim
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Scott P Campbell
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Armand Allkanjari
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Aaron C Lentz
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA.
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[Consensus on HPV of the Portuguese Society of Andrology, Sexual Medicine and Reproduction: Treatment]. Rev Int Androl 2020; 19:150-159. [PMID: 32684426 DOI: 10.1016/j.androl.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 01/19/2020] [Indexed: 11/22/2022]
Abstract
The treatment of condyloma is generally a challenge in clinical practice. Although the spontaneous resolution rate is high, a significant proportion of patients seek treatment, not because of symptomatology, but mainly for aesthetic issues and concerns related to the transmission or worsening of existing lesions. The available treatments should be applied only for clinically evident macroscopic lesions. Ideally, available therapies should have rapid action onset and clearance, resolve symptoms, reduce recurrence rate and viral load, be effective in treating small lesions, and be well tolerated. However, none of the currently available treatments is clearly more effective than the others and there is no ideal treatment for all patients or for all condyloma. Therefore, the therapeutic decision should be based on the clinician's experience, available resources, lesion morphology, size, number and location, primary or recurrent lesions, disease severity, patient preference and expectations, patient's immune competence, convenience, tolerance, cost of treatment and results of previous therapies. The available treatments are divided into three groups: applied by the patient himself (imiquimod 3.75 or 5%, podophyllotoxin .5%, synecatekines 10% or 15%), applied by the health care provider (bi- and tricloacetic acids 80%-90%, intralesional interferon alpha, cryotherapy, surgical removal, electrofulguration, laser ablation) and experimental or alternative therapies (topical cidofovir, intralesional bleomycin, photodynamic therapy). Treatment methodologies can be further divided into their action - ablative or destructive treatment (cryotherapy, electrofulguration, laser ablation, surgical excision), cytotoxic or proapoptotic treatments (podophyllotoxin .5%, 5-fluoruracil, bleomycin) and immunomodulatory treatments (imiquimod 3.75% or 5%, synecatekines 10% or 15%, intralesional interferon alpha). The overall success rate of the various treatments available ranges from 23% to 94%. Only treatments that include cryotherapy or surgical excision are suitable in condyloma with any anatomical location and that have the highest success rate in monotherapy. Recurrences are common regardless of the treatment received. In contrast, immunomodulatory therapies despite having lower initial clearance rates appear to have higher probabilities of cure in the medium term, with low recurrence rates. Some treatments may be combined with each other and the effectiveness of combined therapies appears to be superior to monotherapy (proactive sequential treatment). The consensuses for the treatment of HPV also consider special situations: immunocompromised patients, meatus and intraurethral lesions and treatment of the partner.
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Xie J, Ao C, Li J, Jiang L, Liu H, Zeng K. 5-aminolevulinic acid photodynamic therapy for condyloma acuminatum of urethral meatus. J DERMATOL TREAT 2019; 30:714-717. [PMID: 30427239 DOI: 10.1080/09546634.2018.1544406] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/27/2018] [Indexed: 10/27/2022]
Abstract
Objectives: Condyloma acuminatum are the most common sexually transmitted diseases worldwide, and they are closely associated with human papillomavirus (HPV) infection. Urethral meatus is one of the places that warts occur. Many treatments for uretheral warts have limitations. In this study, we performed 5-aminolevulinic acid-photodynamic therapy (ALA-PDT) on patients and investigated the effectiveness of reducing HPV viral loads. Materials and Methods: In our study, 21 patients diagnosed with urethral condyloma acuminatum were included. After 4 h treatment of ALA, patients received PDT. Each patient received HPV test before every PDT cycle. The frequency of PDT was dependent on viral load changes. Results: All patients achieved complete clinical remission after the last session of ALA-PDT. There were significant differences in HPV viral loads between pretherapy and after one or three rounds of PDT treatment. Conclusions: ALA-PDT is a safe and effective method for treatment of condyloma acuminatum in urethra meatus. Dynamic monitoring of HPV viral loads can more objectively demonstrate the effectiveness and guide the treatment of PDT.
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Affiliation(s)
- Jiajia Xie
- a Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Chunping Ao
- a Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Junpeng Li
- a Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Lifen Jiang
- a Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Hui Liu
- a Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Kang Zeng
- a Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University , Guangzhou , China
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Abstract
Due to the lack of an established school-based immunization program, the initial German public funded girls-only human papillomavirus (HPV)-vaccination strategy failed. Over the last decade, the female coverage rates have not exceeded much more than 40%, thus, missing herd immunity for boys. Therefore, the German HPV immunization program has been revised and currently recommends a gender-neutral HPV vaccination for all children aged 9-14 years to prevent all HPV-related tumors which can be prevented by immunization. In order to correct the mistaken German impression of this being an issue relevant only to females, this article highlights the HPV disease burden in men which mostly can be prevented by timely immunization of boys. German urologists have started a campaign: HPV prevention is a man's business.
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