Treatment of Urethral Lesions with CO 2 Laser by Colposcopy Induced by Human Papillomavirus

Abstract

Background: Urethral Human Papillomavirus (HPV) infection is mostly asymptomatic. The associated low or high-grade HPV lesions are foci of contamination and have a carcinogenic risk. The objective of this study is to describe the urethral HPV lesions and the use of an adapted and relevant treatment. Methods: Sixty nine patients, 59 men and 10 women, were screened by HPV test and found positive for HPV infection and showed urethral lesions. All HPV lesions were biopsied for Haematoxylin and Eosin (HE) histology and p16 immunostaining before CO 2 laser treatment under colposcopy. The patients were followed for 6 months, every 3 months. Results: In 54/69 cases (78.3%), we observed low grade HPV and high grade HPV in 7/69 cases (10%) in the urethra’s lesion. All high grade lesions were confirmed by positive p16 immunostaining.A single HPV genotype was found in 31/69 (45%) of patients, 12/31 (38.7%) of which were high risk (HR) genotypes. HPV low risk (LR) and HR co-infection was found in 21/54 (38.8%) of urethral low grade squamous intraepithelial lesions (U LSIL) and in 1/7 (14%) of high grade squamous intraepithelial lesions (U HSIL). The use of the CO 2 laser with micromanipulator by colposcopy helped by a meatal spreader for visualization of 20 mm in the balanic urethra, allowed us to obtain a cure of 64/69 (92.7%) at 3 months with 4/69 (5.7%) meatotomy and 4/69 (5.7%) at 6 months including two lost to follow-up. Conclusions: High-grade lesions were present in the balanic urethra. Their treatment by CO2 laser by colposcopy with a meatal spreader is a simple surgical intervention with few complications and recurrence preventing the development of HPV-induced neoplasia. Funding Statement: This study was not supported by any funding. Declaration of Interests: The authors declare no competing of interests. Ethics Approval Statement: The study was approved by the ethics group (CPP Ile-De-France III).