Circumcision – a diagnostic and therapeutic procedure for penile lesions due to Human
Papilloma Virus (HVP) infection
Article published in Urologia Polska 2008/61/Supl. 1.
Leszek Walczak, Sławomir Dutkiewicz, Sławomir Majewski, Stefania Jabłońska, Alojzy Witeska
- Klinika Dermatologii i Wenorologii Warszawskiego Uniwersytetu Medycznego
Zakład Profilaktyki i Epidemiologii Onkologicznej Instytutu Zdrowia Publicznego, Wydział Nauk o Zdrowiu Uniwersytetu Humanistyczno-
Przyrodniczego Jana Kochanowskiego w Kielcach oraz Centrum Attis w Warszawie
Centralny Szpital Kliniczny MSWiA w Warszawie
Introduction and objective. Treatment of HVP-related penile pre- and cancerous lesions is an important problem as to the range of surgery (sexual function, quality of life). In low grade lesions – PIN I – anti-inflammatory therapy frequently leads to resolution of such changes. PIN II-III , when accompanied by HVP infection, should be treated with a sparing procedure: enlarged circumcision.
- The aim of the study was to assess therapy in patients with HPV related lesions of the prepuce, retroglangular groove and the glans.
Methods. 56 men, aged 38-74, with phimosis and atypical macular and papular lesions on the glans, foreskin and in the region of the urethral orifice underwent circumcision . They were also subjected to broadened diagnostic work-up: peniscopy, urethral orifice smear for cytology, viral studies for HVP DNA with PCR and Hybrid Capture 2, tests for cellular immunity and histopathologic studies of the specimens.
Results. In 3 men squamous cell carcinoma G3 was found (HPV 16 and 18) treated with partial penile amputation. Spinal cell carcinoma was diagnosed in 4 who underwent total penectomy. In 18 patients carcinoma planoepitheliale keratodes G1 was confirmed (HVP 16), in 11 – papilloma (HPV 11,43), condylomata acuminata in 7 and chronic inflammation in 13. All underwent enlarged circumcision. Follow-up starting in 2000 indicates no relapse.
Conclusions. Full range diagnostic work-up of penile lesions allowed confirmation of viral (HVP) etiology. 90% of the lesions were either benign or malignant. Histologically proven presence of HPV markers in the squamous epithelium is considered an indication for penile-conserving procedure: enlarged circumcision along with lesion resection. Such management allows conservation of the diseased organ: the penis.