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Clinical aspect of laser treatment of lichen sclerosus and squamous cell carcinoma of the penis
Örebro University, Department of Clinical Medicine.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Örebro: Örebro universitetsbibliotek , 2004. , p. 51
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 3
Keywords [en]
Medicin, Penile diseases, lichens, penile neoplasms, lasers, carcinoma, squamous cell carcinoma, sexual function, sexaul satisfaction, medicin
National Category
Dermatology and Venereal Diseases
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-72ISBN: 91-7668-393-1 (print)OAI: oai:DiVA.org:oru-72DiVA, id: diva2:137166
Public defence
2004-06-10, Wilandersalen, Universitetssjukhuset, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2004-05-19 Created: 2004-05-19 Last updated: 2017-10-18Bibliographically approved
List of papers
1. Carbon dioxide laser treatment of lichen sclerosus et atrophicus
Open this publication in new window or tab >>Carbon dioxide laser treatment of lichen sclerosus et atrophicus
1993 (English)In: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 150, no 3, p. 868-870Article in journal (Refereed) Published
Abstract [en]

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.

National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-3148 (URN)8345602 (PubMedID)
Available from: 2004-05-19 Created: 2004-05-19 Last updated: 2017-12-14Bibliographically approved
2. Laser treatment of localized squamous cell carcinoma of the penis
Open this publication in new window or tab >>Laser treatment of localized squamous cell carcinoma of the penis
1995 (English)In: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 154, no 3, p. 1020-1023Article in journal (Refereed) Published
Abstract [en]

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.

National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-3149 (URN)7637046 (PubMedID)
Available from: 2004-05-19 Created: 2004-05-19 Last updated: 2017-12-14Bibliographically approved
3. Combined laser treatment for penile carcinoma: results after long-term followup
Open this publication in new window or tab >>Combined laser treatment for penile carcinoma: results after long-term followup
2003 (English)In: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 169, no 6, p. 2118-2121Article in journal (Refereed) Published
Abstract [en]

PURPOSE:

We evaluated local disease control, side effects and cause specific survival of penile carcinoma treated with laser therapy.

MATERIALS AND METHODS:

In a prospective study from 1986 to 2002 we included 67 men with a mean age of 60 years with newly diagnosed penile carcinoma. No patient was lost to followup.

RESULTS:

At a median followup of 42 months (range 12 to 186) 59 patients were alive and 8 had died of penile carcinoma (2) and concurrent disease (6). Of the 13 patients (19%) with local recurrence during the study period 10 underwent repeat laser treatment successfully. Side effects were few but 5 patients (7%) had postoperative bleeding. Overall cosmetic and functional results were highly satisfactory.

CONCLUSIONS:

The results of this study show that treating penile carcinoma with the combination of carbon dioxide and neodymium:YAG lasers can safely be done with highly satisfactory cosmetic results as well as good local tumor control

National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-3150 (URN)10.1097/01.ju.0000067361.81295.a2 (DOI)12771731 (PubMedID)
Available from: 2004-05-19 Created: 2004-05-19 Last updated: 2017-12-14Bibliographically approved
4. Sexual function and satisfaction in men after laser treatment for penile carcinoma
Open this publication in new window or tab >>Sexual function and satisfaction in men after laser treatment for penile carcinoma
2004 (English)In: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 172, no 2, p. 648-651Article in journal (Refereed) Published
Abstract [en]

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.

National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-3151 (URN)10.1097/01.ju.0000132891.68094.87 (DOI)
Available from: 2004-05-19 Created: 2004-05-19 Last updated: 2017-12-14Bibliographically approved

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