Treatment of condylomata acuminata with the carbon dioxide laser

Holmium:YAG Laser for the Treatment of Genital and urethral Warts: Multicentre Prospective Evaluation of Safety and Efficacy

Introduction: Genital condylomatosis is a highly contagious disease caused by the human papilloma virus (HPV). The aim of this prospective multicentre study was to evaluate the safety and efficacy of the Holmium:YAG (yttrium-aluminium-garnet) laser in the treatment of genital and intra-urethral warts; the secondary aim was to assess the patients' postoperative satisfaction and cosmetic results. Methods: From December 2016 to March 2019, patients with genital warts were prospectively enrolled in three hospitals. The inclusion criteria were male gender, age over 18 years-old and treatment-naïve. External and urethral genitalia warts were treated by the Holmium YAG laser. The follow-up analysis consisted of physical examination, flexible urethro-cystoscopy in case of meatal lesions, and administration of Dermatology Quality of Life Index (DLQI) and Patient Global Impression of Improvement (PGI-I) questionnaires at 1, 3, 6 and 12 months after surgery and subsequently yearly. Results: Sixty patients were enrolled. The single treatment was effective in 57/60 patients (95%). At a mean follow-up of 26 months, recurrences occurred in 8 patients (13.3%). No peri- or post-operative complication occurred. An improvement in pre-operative condition was highlighted with PGI-I and DLQI questionnaires. Conclusion: Our prospective multicentre study showed that holmium laser surgery seems to be a safe and effective treatment for external genital and urethral warts. Good dermatological outcomes aid to further improve patient satisfaction.

Management of Condyloma Acuminata in Pregnancy: A Review

ABSTRACT

No clear guidelines are available for the management of pregnant women with condyloma acuminata, a human papillomavirus-associated benign neoplasm that develops in the genital tract. We performed a systematic review to gain a better understanding of the management of condyloma acuminata during pregnancy. In this review, we mainly focused on treatments. We searched PubMed, Google Scholar, and Web of Science to identify studies on the treatment of condyloma acuminata during pregnancy. Thirty articles met the inclusion criteria. The treatment methods described in the literature were laser therapy, cryotherapy, imiquimod, photodynamic therapy, trichloroacetic acid, and local hyperthermia. The most effective treatment remains unclear. Various factors must be considered when deciding how to treat. Based on our assessment of the literature, we recommend cryotherapy as the first-choice treatment and laser therapy as the second-choice treatment. Imiquimod can be considered in cases such as extensive condyloma acuminata that is not easily treated by cryotherapy or laser therapy. In such cases, sufficient informed consent must be obtained from the patient. Cryotherapy, laser therapy, and imiquimod have been administered during all 3 trimesters with no severe adverse effects, but we cautiously recommend reserving laser therapy until the third trimester because of the lower risk of recurrence before delivery. There are still many unclear points regarding the management of condyloma in pregnancy, and further research is needed.

[New surgical approaches for the treatment of anogenital HPV infections]

HPV infections in the anogenital region may have very heterogeneous clinical features. Most often typical papillomatous condylomata acuminata are observed that usually present no differential diagnostic difficulty. In contrast, the clinical findings of higher grade intraepithelial dysplasias with flat papules and erythematous/ eczematous lesions are often quite inconspicuous and hardly characteristic. The goal of therapy is to prevent further progression to carcinoma, removal of bothersome tumors and avoidance of complications. Surgical methods are preferentially employed for extensive lesions, unfavorable locations and higher grade dysplasia. Options include removal with scissors or scalpel, laser therapy and electrocautery. For purely intraepithelial alterations, superficial ablative techniques are usually preferable over excision. Further developments such as argon plasma coagulation reduce the risk of unwanted deep thermal destruction with the accompanying complications. The risks for the surgeon and the surgical team during treatment should also not be neglected. With consideration of all relevant aspects, the combination of different methods may reduce the risk of complications and frequency of recurrences. Due to the high recurrence rate independent of the selected therapy, consistent follow-up after primary therapy is crucial for the long-term success.

Laser treatment of epidermal and dermal lesions

The CO2 laser is a versatile and effective tool for the treatment of warts and various other epidermal and dermal lesions where there is no easily targeted chromophore other than water. The development of high peak-power short-pulsed or rapidly scanned resurfacing CO2 lasers has significantly improved the safety and efficacy of this treatment modality. Many lesions amenable to CO2 laser vaporization, however, can be treated by other, far less expensive methods, and it is the laser surgeon's responsibility to use the CO2 laser only when it is demonstrably the best treatment option. The pulsed dye laser has some utility for selected recalcitrant warts. Because of their greater safety margin and more precise ablation, resurfacing CO2 and Er:YAG lasers are replacing the continuous wave CO2 laser for the ablation of many superficial lesions.

Laser treatment of warts and other epidermal and dermal lesions

The CO2 laser is a versatile and effective tool for the treatment of warts and various other epidermal and dermal lesions where there is no easily targeted chromophore other than water. The development of high peak power, short-pulse, or rapidly scanned resurfacing CO2 lasers has significantly improved the safety and efficacy of using the CO2 laser. Many lesions amenable to CO2 laser vaporization can be treated by other far less expensive treatment modalities, however, and it is the laser surgeon's responsibility to use the CO2 laser only in cases in which it is demonstrably the best treatment option. The pulsed dye laser may replace the CO2 laser for the treatment of recalcitrant warts if the impressive early cure rates reported are borne out over time. Newer laser systems such as the Er:YAG laser with its extremely small zone of thermal damage may supplant the CO2 laser in the treatment of other epidermal and dermal lesions in the future.

Lasers in anorectal surgery

Laser technology has been applied widely in the treatment of hemorrhoids, condylomas, and anorectal neoplasms. It is claimed by its proponents to result in less pain, improved healing, and more rapid recovery as compared with conventional surgery. Laser therapy, however, is expensive and potentially dangerous, and advantages generally have not been substantiated by controlled clinical trials. The possible benefits and potential risks of laser treatment of anorectal disorders are examined.

Management of 633 cervical intraepithelial neoplasias by CO2 laser: persistent diseases and recurrences

During the past 6 years, we have managed 633 cervical intraepithelial neoplasias with the CO2 laser. If the lesion is located on the ectocervix, the CO2 laser is used to vaporize it under the microscope. If the lesion is located in the endocervical canal, the CO2 laser is used to excise a cylinder-shaped tissue with a handpiece. Colposcopic examination is performed 21 days after treatment. Persistent disease is recognized at this examination; healing is obtained spontaneously in 66% of those with persistent disease without second treatment. There were eight with recurrent disease with abnormal Pap tests and abnormal colposcopic findings, and 12 with recurrent disease with abnormal Pap tests and normal colposcopic findings (recurrent koilocytis cells). After laser treatment cervical function was good and pregnancies were normal.