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Laser surgery is currently considered as an effective alternative in the treatment of several urological diseases. We report on our three-year experience treating recurrent superficial low grade bladder carcinoma in 80 patients using Neodymium: YAG (Nd:YAG) laser. A decrease in local tumour recurrence rate (11%) was observed, but the overall not treated area recurrence was 45%. No complications were noted when the procedure was carried out on outpatient basis. Furthermore, we have been treating successfully urogenital condylomata using Nd:YAG and carbon dioxide (CO2) lasers in 364 patients. In addition we describe the use of Nd:YAG laser in the percutaneous treatment of a patient with bilateral transitional cell carcinoma of the renal pelvis.

Background: Verrucous carcinoma is an uncommon neoplasm whose medical treatment is not well defined., Objective: We report the clinical effects of recombinant alpha-interferon (IFN) with varying dispensing routes on the tumor size in 3 patients exhibiting three different subtypes of verrucous carcinoma., Observations: In case 1, an oral florid papillomatosis of the upper gingiva, a stabilization of the lesion size was observed after the administration of a cumulative dose of 45 million IU of IFN alfa-2b. The patient died after discontinuation of the treatment due to hepatic toxicity. In case 2, a giant condyloma acuminatum of the penis, treatment with a cumulative dose of 522 million IU of IFN alfa-2a first resulted in stabilization of the disease, and no evidence of recurrence was observed after surgical treatment. In case 3, a verrucous carcinoma of the leg, a mild decrease in lesion size was observed after the administration of a cumulative dose of 174 million IU. Surgery was finally required., Conclusion: In reducing the growth of the tumor, treatment by IFN appears to be an adjuvant therapy of verrucous carcinoma, but it never prevents surgery or death.

The authors report the case of a degenerative Buschke-Löwenstein tumor located on the vulva. The authors stress the unusual nature of this disorder, recall its etiopathogenic factors and insist on the necessity for surgery to avoid a transition to malignancy.

The authors report for the therapeutical application of Nd:YAG Laser with wave length 106 nm--MEDILAS 4060N on a genital acute condyloma, caused by human papilloma virus at 19 pregnant women between 10-38 gestation week (g.w.). It is clinical studied a lot of exophytic formations on wide area included vulva, vagina, vaginal portion of uterine cervix (PVCU), perineum and anus. It is marked histological research of the biopsy material from the condyloma for excluding a malignant process, microbiological research of the attendant vaginal and cervical flux, as well as colposcopy of the cases with cervical localisation. It is done a destructive laser-therapy from 1 to 3 seances, depending on the condyloma, a size, count and localization with starting power between 20-30W with exposition time from 0.5 to 1 sec. and diameter of the focal ray--2mm. At the control studies it is found an epithelialization without cicatrices, absence of complications and recurrences during on year.

Purpose: The aim of this study was to determine whether interferon combined with surgical excision and fulguration could reduce the unacceptably high rate of recurrence of anal condyloma seen after surgical extirpation., Methods: Forty-three patients with anal condyloma were prospectively randomized into two groups. Group I (n = 25) patients underwent surgical excision and fulguration immediately followed by an injection of 500,000 IU (0.1 ml) of interferon alfa-n3 into each quadrant of the anal canal. Group II (n = 18) patients underwent surgical excision and fulguration but then received four injections (0.1 ml) of saline into each quadrant of the anal canal., Results: After a mean follow-up of 3.8 months, 10 of 43 (23 percent) patients developed recurrent anal condyloma. Only 3 of 25 (12 percent) interferon-treated patients had recurrences vs. 7 recurrences in 18 (39 percent) saline-treated patients (P = 0.046). Interferon was particularly effective in reducing recurrences in patients whose condylomata were present for more than six months (P = 0.04) and those condylomata that contained human papillomavirus DNA subtype 6/11 (P = 0.05)., Conclusion: Adjuvant interferon treatment can reduce the high recurrence rate of anal condyloma seen after surgical extirpation.

Background and Objectives: We have evaluated the efficacy of CO2-laser in eradicating human papillomavirus (HPV) DNA from genitoanal skin lesions., Study Design: Biopsies of 38 male patients with histologically confirmed HPV-infection after an average of 2 years of follow-up were analyzed. Post-treatment biopsies were obtained from all residual or recurrent HPV-suspect (acetowhite) lesions in 23 patients., Results: After an average of three separate CO2-laser treatments, 15 of 38 patients were devoid of any clinical or acetowhite lesions. By in situ hybridization (ISH), the frequency of HPV-types 6/11 decreased from 52% to 26%, and HPV-types 16/18 decreased from 48% to 17%, respectively, in 23 patients biopsied twice. When ISH-negative biopsies were further analyzed with polymerase chain reaction (PCR) and southern blotting (SB) for HPV-16, HPV-types 16/18 were detected in a total of 65% of biopsies before CO2-laser therapy, and in 61% after the therapy. The cure rate achieved with CO2-laser was 39% (15/38) according to clinical, 61% (14/23) according to histopathological, and 26% (6/23) according to molecular biological criteria. The frequency of Bowenoid papulosis was reduced from 57% (13/23) to 17% (4/23)., Conclusions: Although CO2-laser is ineffective in eradicating HPV genome from therapy-resistant penile warts, the treatment reduces the recurrence of atypical changes and visible warts.

Seventy-seven women with subclinical cervicovaginal human papillomavirus (HPV) changes associated with cervical condylomata and/or mild or moderate cervical dysplasia were studied. All patients were treated with the CO2 laser for cervical lesions (condylomata and/or dysplasia) and, subsequently, based on their contraceptive history, were treated either with 5-fluorouracil (5-FU) cream or trichloroacetic acid (TCA). Those who did not wish to be treated were followed similarly to those who were treated. Overall there was no significant difference between those who had no treatment and those who received TCA or 5-FU. Those treated with 5-FU did more poorly as compared to the other two treatment groups with cervical condylomata and dysplasia at the three- and six-month follow-up (P < .05), and the results for TCA were not different from those in women who were observed and underwent no treatment. It appears that the treatment modalities used in this study did not have any beneficial effect on associated subclinical HPV infections.

A case of condyloma acuminatum in female urethra is reported. A 53-year-old woman was referred to our clinic because of urethral bleeding. A tumor was noted around the external urethral meatus and the size of the tumor was 20 mm in diameter. Excision was performed on the tumor including the external urethral meatus. Pathological examination revealed condyloma acuminatum. Condyloma acuminatum in female urethra is very rare. We reviewed and discussed 6 cases of condyloma acuminatum in female urethra, including our case, in the Japanese literature.

Dysplasia and cancer of the cervix may be related to human papillomavirus infection. To determine the presence of cancer in cases of genital warts we have been using a technique, androscopy, for examining male genitals with magnified lens previously sprayed with white vinegar (5% acetic acid). This paper explores the methods of using colposcopy and androscopy on both sexual partners for a thorough examination of genitals and the anorectal area. It also discusses treatment advantages of the CO2 laser. In our investigation plain, pedunculated warts and a giant condyloma (Buschke-Loewenstein tumor) were found and treated with CO2 laser surgery.

Genital warts and intraepithelial neoplasia caused by infection with human papillomavirus are usually treated with CO2 laser or electrocoagulation. In this study, contamination of personnel and operating theatres with human papillomavirus DNA during treatment sessions was investigated. Samples were taken from the nostrils, nasolabial folds and conjunctiva of the operating physician before and after operating sessions and from Petri dishes left open in the operating theatres. Human papillomavirus DNA was demonstrated by the polymerase chain reaction technique. The results show that there is a risk of contamination of the operator by human papillomavirus DNA, detectable with the polymerase chain reaction technique, during both CO2 laser and electrocoagulation treatment.

Condylomata acuminata are benign epidermal proliferations caused by human papillomavirus (HPV). Recent epidemiological data have shown that HPV infection is the most common sexually transmitted disease. Some HPV types are considered to be potentially oncogenic. Therefore, effective examinations and treatment of both sexual partners are important in all cases. The CO2 laser and the Nd:-YAG laser have gained widespread acceptance in the treatment of HPV efflorescences. CO2 lasers are characterized by surface absorption; the Nd:-YAG laser effect depends on volume absorption; depth of coagulation can be controlled by laser power, spot size and exposure time. Both of these fundamentally different laser effects lead to excellent cosmetic results and high cure rates. Our follow-up examinations revealed recurrences in 22%.

A case of female intraurethral condyloma acuminata is present in this report. A 52-year-old woman visited our hospital with the chief complaint of miction pain and bloody secretions. Thirty seven years previously, she had had a pudental tumor resected which was diagnosed as condyloma acuminata. Physical examination revealed two child-finger-head sized, polypoid tumors which arose from about 5 mm inside the external urethral orifice. Laboratory findings were negative for rapid plasma reagin card test (RPR), positive for treponema pallidum hemagglutination test (TPHA) and Trichomonas vaginalis in urine and vaginal secretion. Under the clinical diagnosis of condyloma acuminata, the tumors were resected. Histological examination revealed koilocytosis with mild dysplasia. The histochemical analysis of human papillomavirus (HPV) by in situ hybridization revealed positive for HPV type 31/33/51 and negative for HPV type 6/11 and 16/18. Histological examinations confirmed that the tumors were condyloma acuminata. No recurrence was seen at the 7th post-operative month.

Purpose: For the patient-administered treatment of anogenital warts, 0.5% podofilox (podophyllotoxin), one of the active compounds of podophyllin, has been shown to be more effective than the vehicle alone. This study was designed to evaluate the safety and efficacy of 0.5% podofilox treatment followed by prophylaxis., Patients and Methods: A total of 103 patients were entered in stage 1 of the study. Stage 1 was an open label study, and patients self-administered 0.5% podofilox twice daily for 3 consecutive days per week for 4 weeks. A total of 100 patients remained available for efficacy and safety analyses. At the end of stage 1, patients who had a complete response proceeded to stage 2 of the study. Patients who had a 50% to 99% reduction in measured total wart area were offered cryotherapy every 10 days, up to 5 times. If cleared of warts, they were also entered into stage 2. A total of 57 patients were enrolled into stage 2, a double-blind, randomized, placebo-controlled prophylactic study of 0.5% podofilox self-administered once daily for 3 days per week for 8 weeks, on the sites of healed warts. A total of 45 patients in stage 2 were available for efficacy analysis., Results: By the end of stage 1, 68% of the warts had disappeared, and 29 of 100 patients (29%) had a complete response. A total of 49 patients had a 50% or greater improvement in wart area and underwent cryotherapy. Rates of local side effects after 1 week of treatment were 57% for inflammation, 39% for erosion, 47% for pain, 48% for burning, and 44% for itching. However, these symptoms and signs were mostly mild to moderate in intensity and diminished over time. Therefore, overall treatment was well tolerated. In stage 2, only 4 of 21 patients (19%) in the podofilox group experienced a recurrence as opposed to 12 of 24 (50%) in the placebo group (P = 0.031). As in stage 1, the side effects were modest, and the drug was well tolerated., Conclusion: This study confirms the efficacy and good tolerance of 0.5% podofilox in the treatment of anogenital warts. It also establishes the safety and superior efficacy of patient-administered podofilox over the vehicle alone as prophylaxis against recurrence of lesions. Although long-term efficacy and tolerance remain to be established, podofilox appears to be a useful agent in the control of this disease.

With the use of a meatourethroscope, 18 patients with intrameatal and distal urethral warts were treated by Nd-Yag laser. Further treatment was carried out with cryotherapy using 140 CryoUnit as required. Sixteen patients were cured of their warts and remained wart-free over a 3-8 month period. Meatourethroscopy proved to be a simple, safe and effective way of treatment of intrameatal and distal urethral warts. It is also an outpatient-based and painless procedure that will complement the treatment of external anogenital warts to achieve complete cure.

Background and Objectives: Anogenital warts frequently recur following ablative treatment, and in the female, has been attributed to the presence of latent HPV infection outside the treatment margins., Goal of This Study: To determine whether HPV DNA sequences were detected by PCR in histologically normal penile skin adjacent to penile warts and to correlate recurrence of warts following surgical ablation to the presence of HPV DNA in histologically normal penile skin., Study Design: Prospective cohort study of 25 heterosexual men with penile warts. Biopsies of clinically healthy penile skin 1 cm from the nearest penile lesion (wart with/without surrounding acetowhite changes) were processed for histology and HPV DNA analysis. The penile wart was processed for HPV DNA analysis only. Recurrence of penile warts was correlated to HPV status of adjacent histologically normal penile skin using Fisher's exact test (FET)., Results: Sequences homologous to HPV DNA were detected in 77% of biopsies of histologically normal penile skin. Agreement in HPV DNA type between penile wart and the adjacent histologically normal penile skin was only 30%. Recurrence of warts was noted in 46% of men by 16 weeks, and was not predicted by the detection of HPV DNA in the adjacent histologically normal penile skin (P = 0.16, FET)., Conclusions: These findings suggest that extending the treatment margins 1 cm beyond the visible lesion is ineffective in eradicating the virus and preventing recurrence of warts.

Cluster condyloma is currently one of the sexually transmitted diseases of higher incidence. The most common sites for condyloma in males are the balanopreputial sulcus, frenulum and the glans' mucosa. Associated to penis condyloma there can be urethral lesions in 5% of patients which in 80% of cases develop less than 3 cm from the meatus. This paper presents a series of 14 cases of cluster intraurethral condyloma managed by transurethral electrofulguration. The technique consists in the introduction of a coagulation probe through the urethrotome and the application of electrofulguration to the condyloma base. Results have been satisfactory although relapse has occurred in 2 cases (14%), and in one of them the procedure had to be repeated up to 3 times. There has been no complications such as stenosis in the loop resections. The authors conclude that due to the difficulties in the medical management of these lesions, the use of invasive techniques, of which transurethral electrofulguration of the condyloma base with endoscopic urethrotome is the choice because of its simplicity and effectiveness, is justified.

Within a period of 2 years 103 patients have been treated with a 50 Watt CO2-Laser because of chronic fluor (20 patients), condylomatous or dysplastic lesions of the portio (39 patients) or after conisation (44 patients). All patients have been treated as outpatients without any local anesthesia. We didn't observe severe complications. 2 times we had to stop laser vaporisation because of bleeding of the portio and had to begin once more after an interval. The patients had been controlled by cytology and colposcopy. The shortest observation time was 6 months. All cytologically controlled patients had a negative PAP-smear. 17 of the 20 patients with chronic fluor mentioned improvement or missing symptoms.

The Nd:YAG Laser is one of the most effective methods for treatment of acute condylomata. This method has been used at the Children Gynaecological Consulting Room at the Desk of Obstetrics and Gynaecology--University of Medicine,Varna, for two years. During this period seven girls (children) were treated (0.6%) from all the patients treated for external genital inflammation. Only one of the cases needed a second laser coagulation (by a non-contact 40 W point with a duration of the impulse of 0.5(-1). A permanent healing was achieved by the 14th day with the application of epithelializing ointment.

A randomized controlled trial was carried out at colposcopy clinics in the Birmingham and Midland Hospital for Women, to determine the efficacy of laser vaporization in the management of cervical Human Papilloma Virus (HPV) infection occurring alone or in association with cervical intraepithelial neoplasia (CIN), and to study the natural history of these lesions. The subjects were 365 women referred for investigation of cytological abnormality who were found to have histological evidence of HPV infection alone or in association with CIN1 or CIN2 and were considered suitable for local destructive treatment. The intervention consisted of immediate treatment using a carbon dioxide laser or no treatment. Women in both groups were followed by cytological and colposcopic examinations at intervals of four months. Twelve months after randomization, 25 per cent of women in the non-treatment group had progressed to a more severe degree of histological abnormality compared with 4 per cent in the treatment group (95 per cent confidence interval (CI) for difference in proportion 14-28 per cent). Spontaneous regression of cytological abnormality occurred in 26 per cent (95 per cent CI 19-33 per cent) of untreated women. It is concluded that the short-term efficacy of laser vaporization in the treatment of these lesions has been established. The substantial rate of spontaneous regression suggests, however, that intervention is frequently unnecessary.

We report on a 67-year-old man with a large papillomatous tumour of the penis clinically resembling verrucous carcinoma. HPV 6 and HPV 11 DNA could be isolated by hybridization techniques. The tumour showed exclusively exophytic growth with anastomosing acanthosis and papillomatosis. Groups of vacuolated cells were present in the spinous and granular layers. Endophytic and destructive proliferations and cytologic criteria of malignancy were absent. This tumor was a giant condyloma acuminatum and not either a Buschke-Löwenstein tumour or a verrucous carcinoma. There was no recurrence 2 years after local excision. The differential diagnosis of giant condylomas and Buschke-Löwenstein tumours is discussed.

The relation between sexual practices and location of anogenital warts is discussed. Results were derived from clinical examination and interview of 56 consecutive male patients referred to CO2-laser treatment of therapy-resistant genital warts, at a clinic at the Department of Dermatovenereology, Gentofte Hospital, located in the northern area of Copenhagen. Twenty (100%) patients with anal warts and 36 (100%) patients with penile warts all claimed to be strictly heterosexuals. None of the patients interviewed had had anoreceptive coitus or been engaged in sexual practices with oro-anal contact. The study population otherwise had a heterosexual profile with approximately one fifth of the patients having had other sexually transmitted diseases, mainly chlamydia. The group of patients with anal warts had significantly fewer known sex partners with genital warts (25% versus 58%, p < 0.05) compared to the patients with penile warts. All patients received one or more CO2-laser treatments using local anesthesia, resulting in cure rates of 80% (16/20) and 89% (32/36) in men with anal warts and penile warts, respectively. Anal warts seem to be much more common in a heterosexual male population. There is a need to elucidate the nature and epidemiology of anal human papillomavirus infection in heterosexual males.

The treatment of condyloma acuminatum in children is still controversial. The ideal treatment should take into account the efficacy of eradicating infection, but also the child's tolerance of treatment and its ease of use. Twenty cases observed by the authors over the course of the past 10 years are described. A treatment protocol is drawn up on the basis of a review of the latest reports on this topic and the availability of new products.

Condylomata acuminata are very rare in children, although the prevalence of clinically or cytologically visible human papilloma virus infections is high. We report on a 28-year old G IV, P II with genital warts at the time of delivery, who had a baby boy without any signs of HPV-infection. The condylomata of the mother persisted, and subsequently laser vaporisation was performed one year after delivery. One year after laser therapy, a recurrent HPV-infection in the mother was detected. At this time, her two year old son had condylomata on his scrotum. The same serotypes, HPV 6 and 11, could be identified in the mother and child. With this case report, we discuss the possible ways of transmission and consequent clinical management of HPV infections in pregnancy.

Forty-two prepubertal children presenting with anogenital (AG) warts (15 boys and 27 girls) were prospectively followed up (mean 15.9 months, SD 12.24). Most (73.8%) of these children had perianal condylomatous-type warts and 11 (26.2%) had concurrent non-genital (NG) warts. None had any other AG infections or sexually transmitted disease (STD). Twelve (28.6%) children acquired their AG warts by vertical transmission from an infected maternal birth canal, 3 (7.1%) by autoinoculation from common hand warts and 2 children (4.8%) through sexual abuse. In the remaining 25 children (59.5%) mode of acquisition of AG warts was uncertain but not thought to be sexual. Human papilloma virus (HPV) DNA (types 6/11, 16/18 or 31,33,35-31+) was detected in 10/32 (31.3%) of AG warts biopsied from these children, types 6/11 in the majority of positive biopsies (9/10). Detection of HPV DNA (types 6/11, 16/18 or 31+) in a child's AG warts was significantly associated with either vertical or sexual transmission (P < 0.02). Thirty-one children had their warts treated with a combination of scissor excision and electrocautery under general anaesthesia. Warts recurred in 10 (31.4%) of these children all within 4 months following treatment. Spontaneous resolution of AG warts was seen in 9 (21.4%) children. Of 42 children with AG warts 10 (23.8%) had at least one adult family member with AG warts, 13 (36.9%) on adult family member with another AG infection or STD, and 23 (62.2%) had a mother with cervical intraepithelial neoplasia (CIN). Twenty (47.6%) of these children had a family member with NG warts.(ABSTRACT TRUNCATED AT 250 WORDS)

In an open prospective study 67 patients with refractory genital warts, irrespective of anatomic localization, received CO2-laser vaporization in local anaesthesia, using lidocaine 2% as the local anaesthetic. Sufficient anaesthesia was obtained in all treated patients, with minor pain as the only side effect observed. A single CO2-laser treatment resulted in disappearance of the lesions in 37 (55%) of the patients. Repeated CO2-laser vaporizations in patients with recurrent disease increased the cure rate to 85%. The response rate seemed unaffected by the localization of the warts. It is concluded, that local anaesthesia might replace general anaesthesia in the treatment of patients with multiple refractory genital warts.

From May 1990 to April 1992 we used intramuscular beta-interferon to treat 17 patients with CIN associated with HPV virus (9 cases CIN1 and 8 cases CIN2) and 10 patients with genital condylomas without CIN. The dosage employed was 3.000.000 IU/daily/7 days and every other day for a further 14 days. All patients were followed up at 1,3 and 6 months and some for longer. Complete cyto histological resolution of CIN was achieved in 58% of patients: however the HPV remain cytologically present in 64% of cases. The data presented are encouraging though they confirm that it is difficult to completely eradicated the genital HPV. In patients with genital condyloma the condition persisted in 66% of patients receiving only medical treatment, whereas in those treated with beta-interferon and dyatermocoagulation the recurrence rate was 28%.

The case of a 34-year-old female is reported, who has suffered from recurring condylomata acuminata of the anogenital region since she was 16. In the further course of the disease multiple Buschke-Loewenstein tumors developed, and finally an invasively growing, highly differentiated, keratinizing squamous cell carcinoma. The course of the disease was complicated by severe septicemia. In the framework of multimodal therapy, laser resection was the preferred method of surgical intervention. A systemic or local interferon treatment has only a prophylactic character in this stage of the disease.

In this prospective study, three groups of patients were enrolled: group 1, patients with high grade squamous intraepithelial lesions (CIN 2 and 3) and carcinoma in situ (n = 56); group 2, patients with benign vulvar and perineal human papillomavirus lesions (n = 83); and group 3, patients with disseminated foci of penile shaft condylomatous lesions (n = 65). Each of the groups was randomly equally divided into two subgroups. One subgroup was treated with a laser beam with an output of 60 W and a spot size of 1-1.5 mm, creating high power density (HPD) ranging between 3,4000 and 7,640 W/cm2, while the other was treated with low power density (LPD) with an output of 20 W and the same spot sizes, creating an LPD ranging between 1,136 and 2,547 W/cm2. In group 1, the time to complete treatment was shorter using the HPD technique (P < .0003), and more satisfactory histologic edges were available (P < .007). HPD was also associated with a significantly shorter healing time and improved cosmetic results in groups 2 and 3 (P = .001). No difference was found in the time to complete therapy or the occurrence of infection when the different modalities were compared. The results of this study suggest that for specific disease entities, HPD is associated with better treatment outcomes than is LPD.

A 4-year-old boy was referred for treatment of papillary tumor at the urethral meatus. He was well until December 1990, when his mother noticed a tumor at the urethral meatus. The tumor was resected elsewhere. However, a similar tumor was noted again at the urethral meatus in May, 1991. The patient was admitted on September 16, 1991. Retraction of the phimotic foreskin revealed a well-demarcated papillary mass, approximately 2 x 2 mm in diameter, at the urethral meatus. There were no tumors on foreskin or glans. Under general anesthesia endoscopy was performed to locate other tumors at the urethra and bladder. No tumors were found elsewhere. Then the meatal tumor was resected surgically. Pathology was condyloma acuminatum. There was no recurrence one year after surgery. We also reviewed 24 boys with condyloma acuminatum, including 13 boys with a solitary condyloma at the urethral meatus, reported in Japan.

Eighty-four women with acuminate warts of the external genital tract were treated with two methods of laser vaporization. Patients were classified by lesion number and volume (1+, 2+, 3+). Thirty-three patients had only the lesions vaporized, whereas 51 had individual lesions vaporized followed by the "brushing" technique applied to the surrounding mucosa. Postoperative discomfort and pain were worse in those patients who had the brushing technique. The results were assessed colposcopically six to eight weeks postoperatively. Regardless of the method of laser vaporization, the majority of patients with extensive disease (2+ or 3+) had persistent lesions, although reduced in number in most instances. Patients with relatively few lesions (1+) had complete elimination of the warts whether or not brushing was employed. Based upon this study, reducing the burden of acuminate warts before laser vaporization is recommended.

Objective: To determine whether interferon alpha-2a, when utilised as adjuvant chemotherapy following ablation of condylomata acuminata (genital warts) by cryotherapy, is effective in the prevention of recurrences., Design: Randomised, placebo-controlled, double-blind study. Statistical analysis was by 2-tailed Fisher's Exact Test., Patients: 97 patients with recurrent condylomata acuminata., Intervention: 49 patients were treated with cryotherapy plus subcutaneously administered interferon alpha-2a, and 48 received cryotherapy plus placebo. Of these, 36 and 37 patients, respectively, completed the study and were evaluable., Main Outcome Measure: Clinical eradication of condylomata for six months following adjuvant chemotherapy., Results: By completion of the adjuvant chemotherapy, 10 (28%) interferon recipients and 16 (43%) placebo recipients experienced recurrences. At six months follow-up, 25 (69%) interferon and 27 (73%) placebo recipients experienced recurrences. In the six months following interferon therapy, only 31% of interferon and 27% of placebo recipients remained free of recurrences (p = 0.99)., Conclusions: Interferon alpha-2a administered subcutaneously offers no benefit as a chemotherapeutic adjuvant to cryotherapy when used alone in the therapy of genital warts in this population of patients with recurrent condylomata.

Photodynamic therapy (PDT) with Photofrin II was administered over a 7-year period to 17 patients with recurrent carcinoma in situ (CIS) of the vulva, vagina, and perianum. Ten patients were treated two or three times after average intervening periods of 23 and 19 months, respectively. A histologically complete response at 3 months after the PDT session was achieved for 27 of 38 (71%) anatomic sites. Ten patients of this group remain free of recurrences for periods of 2-7 years. Condylomata acuminata associated with CIS in 16 of 17 patients recurred rapidly in 7 patients after PDT. Only short-term palliative results were achieved for 4 patients treated with PDT for invasive carcinoma. Fifteen patients experienced a significant skin reaction to direct sunlight during a 7-week period post-PDT.

Perianal condyloma acuminatum is a lesion rarely seen in children or babies. We report three new cases of this disease in children less than 3 years of age. There was no evidence of the mechanism of transmission in these cases. All patients underwent radical surgical excision. In one case, surgical treatment was needed on two different occasions due to the extension of the warts. None of the patients showed any recurrence of condyloma over a follow-up period of six years.

Between 1982 and 1990, 4 males with extensive intraurethral warts presented with marked inflammation of the external genitalia. When sepsis had settled all patients underwent ventral urethrotomy, in which the urethra was divided median as far back as was necessary to expose all of the warts. Surgical and electro-excision were the preferred methods of removal. Of 3 patients who developed recurrences 2 were lost to follow-up. A third remained without treatment for 1 year and when next seen the warts had spontaneously resolved and his urethra was closed. A fourth patient was lost to follow-up for 4 years before returning with destruction of his external genitalia by a verrucous carcinoma. The human immunodeficiency virus (HIV) did not appear to be a factor in the natural history of intraurethral warts in 2 patients who were negative for serum antibodies 2 and 8 years after presentation.

Treatment of genital warts (HPV lesions) by Laser-surgery was performed in 90 patients and 90 male partners under topical anaesthesia with 1-3 gr EMLA cream and in 45 patients and 45 males (control groups) under 1-2 ml 2% Carbocaine infiltration. EMLA cream was applied to warts 5-18 minutes (median = 7) before operation. Pain from application of anaesthetic and Laser surgery was significantly less (p < .001) in the groups treated by EMLA. Side effects were minimal in the EMLA groups. The results suggest that EMLA cream could be the anaesthetic of choice in Laser surgery of genital warts.

Twenty-six patients presenting condylomata acuminata are operated with CO2 laser (two in outpatient conditions), and 22 of them (84.61 per cent) estimate the pain as mild. Recurrence of the disease is registered in one case (3.85 per cent), but most likely it is a matter of minor vegetations, missed during the operation. In extensive condylomatous vegetations, CO2 laser is applied in conjunction with electrocautery in a fashion to obviate the side effects relating to electroresection. In five patients the laser radiation toxic effect on HPV is demonstrated for the first time by the filtered in situ hybridization method. It is worth noting that the therapeutic approach suggested combines radicality and efficiency of treatment, with the patients running an uneventful and painless postoperative course.

Infection of the genital organs by human papillomavirus (HPV) is the most commonly diagnosed sexually transmitted disease. Papillomaviruses lead to a contact infection of the epithelium and present with different clinical and histological signs. With the exception of the best known clinical manifestation Condylomata acuminata, subclinical infections can be only diagnosed from a stepwise examination. Physiological results from both men and women may be falsely explained as being caused by viruses, and can lead to an incorrect therapy. Genital papilla (Papillae coronae vulvae et glandis) present as atavistic cutaneous papilla a normal situation but with functional significance. Differences in clinical symptoms as well as the possibilities of further differentiation can be obtained by means of pictures taken during colposcopy.

This paper presents a brief description of current uses of the carbon dioxide, neodymium:yttrium aluminum garnet, and other lasers in common general surgical procedures. It focuses on the author's own experiences and includes a review of the current literature.

Within a period of two years 205 patients of our colposcopy-laser-outpatient department have been treated with a 40 Watt CO2-laser. 97 patients had dysplastic or condylomatous lesions of the portio, 85 ones condylomas in the vulvar, vaginal or perianal regions. 70 per cent of laser vaporisations had been done ambulatoryly. Complication rate following laser conisation was 12 per cent, following laser vaporisation 0 per cent. The rate of recurrent or persistent dysplasias was 12 per cent, of condylomas 18 per cent on an average observation time of 16 months.

Genital papillomavirus is an infection sexually transmitted, besides it is frequently associated with cancer of the uterine cervix. It is controversial if it is useful to treat the sexual partner. The present study analyzes in a comparative way patients with CIN with treated partner and untreated partner. From 1986 to 1991 251 women treated for CIN, were prospectively studied; they had completed a one year follow up and during this time they presented, or not, treatment failure. Fifty six were examined and their sexual partners were treated for genital papillomavirus, and the control were 195 women, similar to the study group as to age, race, socio-economical level, CIN histological degree, distribution of lesions and therapeutical methods, in whom the male was not examined nor treated. Statistical methods were Umann-Whitney, homogeneity test, and the fractions difference test to compare the groups. It were obtained the persistence and recidive of the treated couple and untreated couple (41% vs 32.8% with P greater than 0.05) not significant, which shows that papillomavirus treatment of the male partner has no effect on CIN treatment failure in the woman. These statistical results should be considered with caution as it is known that the male is a virus reservoir that together with other cofactors may explain the greater risk for the woman to develop CIN.

A questionnaire on the treatment of anogenital warts was sent to 150 consultants in genitourinary medicine, 78 (52%) were returned completed. A wide range of treatments were used; podophyllin was the commonest first line treatment of multiple penile (60.3%), perianal (57.7%) and vulval (61.5%) warts. Cryotherapy was a popular choice for intrameatal warts (65.3%), small numbers of vulval warts (33.3%) and as second line therapy for penile (35.9%) and perianal (33.3%) warts. Vaginal warts were treated with podophyllin (39.7%) or cryotherapy (29.5%). Various combinations of podophyllin, trichloroacetic acid and cryotherapy were used (2.6%-24.3%) although there is no evidence this offers benefit over single therapy. Podophyllin is frequently used despite side effects, a poor clearance rate and in vaginal warts, difficult access. Initial therapy with more time-consuming procedures such as cryotherapy or electrocautery may be of benefit to selected patients.

Objective: To assess whether cold coagulation to the cervix eliminates subclinical wart virus infection and to determine the effectiveness of treatment for CIN I and II, using cold coagulation, by genitourinary physicians., Design: Prospective study., Setting: Department of Genitourinary medicine in a large teaching hospital., Participants: All patients who received cold coagulation to the cervix in a 1 year period, who had not had previous treatment., Results: 261 patients were enrolled into this study; of these, 138 (53%) patients attended for repeat colposcopy and cytology at one year. Cure rates for lesions were 66% for initial wart virus infection, 80% for CIN I and 94% for CIN II and III. Four (5%) cases in whom repeat cytology was normal had CIN which would have been missed if repeat colposcopy had not been performed at one year., Conclusions: Cold coagulation is inappropriate treatment for subclinical wart virus infection of the cervix but is useful for the management of patients with CIN. Repeat colposcopy following treatment to the cervix is not necessary if cervical cytology is normal.

Over a 6-year period, 40 young women under 20 years of age with cervical intraepithelial neoplasia (CIN) grade I (58%) to grade III (10%) were treated by laser vaporisation or excisional conisation. This prevalence of CIN in young women (nearly 4% of laser-treated cases) underscores the need for detection of cervical abnormalities in all teenagers engaged in sexual relations. The colposcopically-guided carbon dioxide laser technique is the treatment of choice for vaporisation and conisation of intraepithelial lesions (extending to the periphery of the cervix in 20% of cases) and for vaporisation of associated condylomatous lesions of the cervix (75%), vagina (23%), vulva (48%) and/or anus (8%).

Seventeen male patients with recalcitrant genitoanal warts, who had been unsuccessfully treated with classical destructive modalities for 16 months on average, were included in an open uncontrolled trial. The treatment regimen consisted of caustic and/or surgical measures as judged optimally suited in the individual cases, combined with an intermittent systemic low-dose adjuvant interferon-alpha-2c regimen (3 or 6 5-day-courses with intervals of 2 weeks) followed by a 1-year-observation period. At the end of interferon treatment, no patient had clinically visible warts but 10 still had subclinical acetic acid positive lesions. At the end of the 1-year-observation period, clearance of both warts and acetowhite lesions was observed in 4 patients (23.5%), whereas acetowhite lesions persisted in 4 others (23.5%). Recurrence of clinically visible lesions, always within the acetowhite areas, was observed in 9 (53%) patients. Interferon may thus have been effective in suppressing clinical recurrences of genitoanal warts, but its potency to eradicate subclinical papillomavirus infection was disappointing.

The main goal of the therapy of human papillomavirus (HPV) infection is the management of the virus. There is no cure for HPV infections. The treatment goal for the female patient is to destroy lesions that are malignant or premalignant. The male patient is treated because he is a carrier of HPV who can infect previously uninfected women and possibly reinfect an already treated partner with a potentially oncogenic virus. Various treatment modalities are discussed.

The presence of vulvar condylomata acuminata shows evidence HPV infection of the vulva. 49 patients with such lesions came to our hospital for laser treatment. At that time, none of the patients were aware of their cervical disease. Colposcopy and biopsy of the cervix revealed in eight (16%) of the 49 patients CIN I and CIN II in one patient (2%). Condylomata or other HPV-associated lesions were found in seven patients (14%) and cervicitis in two (4%). HPV were detected in the cervix in 23 patients (46%). HPV types 16 and 18 were found in seven patients (14%) and HPV types 31, 33 and 35 in four patients (8%). It is concluded, that patients with condylomata acuminata of the vulva have a high risk of developing CIN and should undergo colposcopy.