Is carbon dioxide laser treatment of lichen sclerosus effective in the long run?

OBJECTIVE: To evaluate the long-term results after carbon dioxide laser treatment of lichen sclerosus. MATERIAL AND METHODS: We evaluated 62 consecutive patients with histologically verified lichen sclerosus admitted between 1985 and 1991. All patients were treated with a carbon dioxide laser with an output of 15-20 W and a defocused beam. This treatment vaporized the macroscopically altered area of the glans penis. Phimosis and superficial meatal stenosis were treated at the same session. Fifty-three men were still alive in 2004, and we were able to contact 50 of them (94%). The patients were asked about recurrence of symptoms, any visible penile lesion and recurrence of meatal stenosis. All patients who reported symptoms were invited to visit the outpatient clinic for further examination. RESULTS: The median follow-up time was 14 years. At follow-up, 40 patients (80%) had no local symptoms and no visible lesion. Ten patients had minor symptoms but only two required further treatment. CONCLUSION: Long-term follow-up of carbon dioxide laser treatment of lichen sclerosus shows that the treatment is safe and gives good results.

Sexual function and satisfaction in men after laser treatment for penile carcinoma.

PURPOSE: We evaluate sexual function, sexual satisfaction and cosmetic results after laser treatment of penile carcinoma. MATERIALS AND METHODS: A total of 67 patients were treated at our clinic for penile cancer using combined carbon dioxide and neodymium:YAG lasers from 1986 to 2000. At the time of this study 58 men, with a mean age of 64 years were alive, of whom 46 (79%) agreed to participate in a structured face-to-face interview addressing sexual function, sexual satisfaction and cosmetic results. The length of time that had elapsed since treatment ranged from 6 months to 15 years (median 3 years). RESULTS: Of 40 patients (87%) who had been sexually active before treatment 30 (75%) had resumed activities at the time of the interview. Unaltered erectile function after treatment was reported by 33 patients (72%), 10 patients (22%) reported decreased function and 3 (6%) reported improved function. Of the 46 patients 23 (50%) were satisfied/very satisfied with their sexual life. After treatment only 3 of 30 (10%) of the evaluable men had dyspareunia. The cosmetic results were considered satisfying/very satisfying by 36 (78%) men. CONCLUSIONS: Laser treatment of localized penile carcinoma preserves the penis and generally provides satisfactory sexual function and cosmetic results.

EAU Guidelines on Penile Cancer.

OBJECTIVES: The European Association of Urology (EAU) consensus group on penile cancer has prepared these guidelines to help urologists assess the scientific evidence for the management of penile cancer and to incorporate recommendations into their clinical practice. METHOD: References used in the text have been assessed according to the level of scientific evidence involved and guideline recommendations have also been evaluated according to the Agency for Health Care Policy and Research [Clinical Practice Guidelines Development: Methodological Perspectives. Washington DC: US Department of Health and Human Services, Public Health Service; 1992, pp. 115-127]. RESULTS: The diagnosis, treatment and follow-up of patients suspected of, or diagnosed with, penile cancer is listed as an easy reference text. CONCLUSION: A guidelines text is presented which aims at aiding medical specialists in determining the most optimal diagnostic and treatment options for this pathology.

Xanthogranulomatous pyelonephritis--an unusual renal disease in childhood.

We report on a 6-year-old boy with Xanthogranulomatous pyelonephritis. This unusual type of renal inflammation has a typical clinical picture that is important to bear in mind. The affected child is often seriously ill with a palpable flank mass leading to initial suspicion of malignancy. Modern imaging procedures help in obtaining a pre-operative diagnosis.

Laser treatment of localized squamous cell carcinoma of the penis.

PURPOSE: We evaluate the efficacy and morbidity of laser and conventional treatment in 32 men with penile cancer. MATERIALS AND METHODS: Of 32 men treated for squamous cell carcinoma of the penis observed for an average of 44 months 19 were treated with the combined carbon dioxide and neodymium: YAG lasers. The 13 patients treated conventionally had more advanced disease and they were a mean 17 years older than those in the laser treated group. RESULTS: All laser treated patients were disease-free after a mean of 31 months. Among the 13 conventionally treated patients there were only 5 long-term survivors. CONCLUSIONS: The cosmetic and functional outcome of laser treatment for stages Tis to T2N0M0, grades 1 and 2 squamous cell carcinoma of the penis is excellent, and the associated morbidity rate is low.

Uptake and distribution of intravenously or intravesically administered photosensitizers in the rat.

Photodynamic therapy using i.v. injected porphyrin photosensitizers have been used to treat selected cases of superficial bladder cancer. Since cutaneous photosensitivity, lasting 6-8 weeks, is a well known undesirable side effect of this therapy, we instilled the photosensitizers intravesically in rats and compared the uptake of photosensitizers in different tissues by this route of administration with the uptake after intravenous injection. The intravesical mode of delivery enhanced photosensitizer uptake in the bladder wall, while giving low concentrations in extravesical organs. Intravesical instillation of the photosensitizers may therefore increase their efficacy and reduce phototoxicity as compared with intravenous injection. Comparing the results obtained by two assays, one based on porphyrin fluorescence and the other based on the application of radioactively labelled photosensitizers, it was concluded that the i.v. administration route may result in tissue uptake of significant amounts of aggregated non-fluorescent, supposedly inactive drug, while the intravesical administration led to less uptake of aggregates relative to active drug monomers.

Carbon dioxide laser treatment of lichen sclerosus et atrophicus.

We followed 62 men treated with the carbon dioxide laser for lichen sclerosus et atrophicus for an average of 30 months (3 months to 7 years). Of the patients 47 (76%) became asymptomatic and 10 (16%) had minor residual symptoms. In 26 patients (40%) concomitant superficial meatal stenosis was simultaneously treated with laser meatotomy. The cosmetic and functional results of treatment were highly encouraging. Provided that radicality is achieved at the primary application, the carbon dioxide laser is an excellent therapeutic modality for lichen sclerosus et atrophicus.

Two years' experience with photodynamic therapy of bladder carcinoma.

Eleven patients with intractable bladder carcinoma who were either unfit for radical surgery, or had refused it, were treated with whole bladder photodynamic therapy. Seven patients had carcinoma in situ and 4 had papillary tumours. Four of the 11 patients had recurrent tumours after a full course of radiotherapy for invasive bladder cancer. A complete local response was initially achieved in 9 patients with a mean follow-up of 12 months. The patients previously treated with radiotherapy had a remarkable response, with local control in all cases, but they had severe local side effects and a pronounced reduction in bladder capacity. In the non-irradiated group, bladder capacity was reduced permanently in only 1 of 7 patients.

Neodymium-YAG laser treatment in localized prostatic cancer. High rate of local failure.

Clinically localized prostatic cancer, T0-2,NX,M0, was treated with extended transurethral resection and subsequent neodymium-YAG laser irradiation of the prostatic cavity in 20 patients in 1987-1990. The patients' mean age was 71 (range 64-84) years. During 12-month follow-up only three patients had negative biopsies, whereas 16 had residual cancer and one had atypical, suspectedly malignant cells. Eight of the 16 with residual cancer underwent repetition of the combined resection and laser treatment, but this led to negative biopsies in only two cases. The treatment per se was well tolerated and side effects were few, but the poor outcome concerning local tumor control is contradictory to previous reports and raises doubts as to the advisability of offering such treatment as an alternative to radical prostatectomy.