Transurethral Laser Ablation of Urethral Condylomas

K. Jain, A. Popovic, M. Pandher, C. Berg, A. Alwaal

Urethral condylomas, minimally invasive, urethral sparing, laser ablation

INTRODUCTION AND OBJECTIVE:

Treatment options for urethral condylomas include an 8-week course of 5-FU, surgical resection, or urethrectomy. For patients with extensive disease, we describe an alternate approach using urethra-sparing laser ablation.

METHODS:

We present a case involving a 35-year-old male veteran who initially presented due to intermittent gross hematuria and blood at the meatus without any obstructive symptoms. He has no past medical or surgical history and is a non-smoker. His hematuria workup was negative, and flexible cystoscopy has demonstrated panurethral condylomas, confirmed via biopsy.

A 365-micron laser fiber was used, and each lesion was targeted at settings 1 J and 30 Hz. Hemostasis was achieved with settings of 0.8 J and 20 Hz. Throughout the procedure, we intermittently drained the bladder via the cystoscope to prevent overdistention and efficiently remove disintegrated condyloma debris.

After confirming all visible condylomas were ablated, we conducted a final urethroscopy to ensure complete hemostasis, and an 18 French Foley catheter was placed for 3 days.

RESULTS:

The patient experienced no postoperative complications and successfully passed the voiding trial on postoperative day 3. At a 6-week follow-up cystoscopy, he reported no symptoms such as dysuria or hematuria. The cystoscopy showed a solitary tiny, <1mm, residual lesion on the right dorsal aspect of the proximal penile urethra, with no other urethral or bladder involvement. The patient is scheduled for a repeat laser ablation in 4 weeks.

CONCLUSIONS:

This case showcases a safe and effective urethra-sparing approach to treat extensive urethral condylomas using the holmium laser.