Total resection of glans penis surface by CO2 laser microsurgery

Fifteen patients underwent resection of the whole glans surface with laser microsurgical technique from May 1983 to September 1987. The operations were performed in one stage in 11 cases and in two stages in 4. In 3 cases the resected lesions represented multiple dysplasia grade III or carcinoma in situ, in 1 case hyper/parakeratosis and penile horn, and in 11 cases superficial squamous cell carcinoma. In 8 cases primary superficial and flat tumors occupied more than half the circumference of the organ, and in the remaining 7 cases there were flat, superficial residues after systemic chemotherapy for exophytic, non-infiltrating carcinomas. The CO2 laser beam was used under constant microscopic visual control at a mean output power of 20W, CW or pulsed for the tissue excision from the meatus to the sulcus level. Maximum depth of resection was 2.6 mm. Postoperative external radiotherapy (60 Gy) was given in the first case of the series (microscopically invasive cancer). Satisfactory cosmetic and functional results were observed in all cases. During the follow-up period, ranging from 2 to 48 months, persistent cancer was found at the perimeatal area in 1 case 4 months after laser resection. The procedure can be considered for conservative treatment of wide or multiple superficial lesions of the glans penis.