Clinical aspect of laser treatment of lichen sclerosus and squamous cell carcinoma of the penis

University dissertation from Örebro : Örebro universitetsbibliotek

Abstract: The aim of these studies was to investigate the efficacy, complications and the long term results after laser treatment of lichen sclerosus et atrophicus and of squamous cell carcinoma of the penis.Patients and Methods: Paper I: In a prospective study from 1985-1991, 62 men with histologically verified lichen sclerosus et atrophicus were given carbon dioxide (CO2) laser treatment following the failure of local corticosteroid treatment. The study was subsequently updated at a median follow-up time of 14 years.Paper II-IV: Sixty-seven men aged 26 to 87 (mean 60 years) with newly diagnosed penile carcinoma were included in a prospective study. The patients were treated by a new combined laser method (CO2 and Nd:YAG) between 1986 and 2000. The median follow-up time was 42 months (range 12-186 months). All patients could be assessed for local recurrence, progression and survival at the end of 2001. Forty-six patients agreed to participate in face-to-face interviews addressing sexual activity, sexual function/dysfunction, satisfaction and cosmetic results.Results: Paper I: The laser treatment was successful in 47 patients (76%) with no local symptoms at a mean follow-up of 30 months. Fifty-three of the 62 men were alive when the update was carried out in February 2004, and we were able to get in contact with 50 of them. Forty of these patients (80%) had no local symptoms or visible lesion. We found concomitant squamous cell carcinoma of the penis in two patients and two further patients had died from anal cancer.Paper II-IV: Local recurrences appeared in 13 patients (19%) at a median follow up of 42 months, and 10 of these patients were successfully retreated with laser treatment. Two patients died from penile carcinoma. The disease-specific 5-years survival rate was 95%. Concomitant lichen sclerosus was found in 11 patients. All patients younger than 75 years reported that they were sexually active before the treatment, and 80% of them had resumed their sexual activity after the treatment. Ten patients (22%) reported decreased erectile function after the treatment, while 33 patients (72%) reported unaltered erectile function. The cosmetic result was regarded as satisfying or very satisfying in 78% of the patients.Conclusion: Carbon dioxide laser treatment is an efficient treatment for lichen sclerosus et atrophicus with excellent long-term results, and the side effects are few. One disadvantages of the treatment is a slow postoperative healing process. Combined CO2 and Nd:YAG laser treatment is effective for treatment of the primary tumour in patients with localized penile carcinoma. It can be safely carried out with good local tumour control and highly satisfactory results with respect to cosmetic aspects and sexual function.

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