High-grade and low-grade HPV-induced urethral lesions treated by CO₂ laser under colposcopy

This study is reporting the CO₂ laser treatment efficiency on urethral lesions caused by human papillomavirus (HPV) and the correlation between the type of lesion high-grade and low-grade on the histology and the HPV genotype(s).

Sixty-nine patients (59 men and 10 women) with urethral lesions were screened for HPV genotype(s) by in situ hybridisation and PCR. HPV lesions were biopsied and p16^INK4a expression was tested to confirm urethral high-grade squamous intraepithelial lesions (U HSIL) on the histology prior to CO₂ laser treatment under colposcopy. The patients were followed up for 12 months.

We observed urethral low-grade squamous intraepithelial lesions (U LSIL) in 54/69 cases (78.3%) and U HSIL in 7/69 cases (10%) confirmed by p16^{INK4a staining}. Then we looked at the HPV genotype present in each lesion. We observed the following: 31/69 (45%) patients have a unique HPV genotype, with 12/31 (38.7%) of high risk; 21/54 (38.8%) of U LSIL and 1/7 (14%) of U HSIL have HPV low-risk and high-risk coinfections. Efficient treatment with CO₂ laser under colposcopy was done using a meatal spreader to help visualisation of 20 mm in the distal urethra. We cured 64/69 (92.7%) patients at 3 months with 4/69 (5.7%) meatotomy and persistent 1/67 (1.4%) urethral stricture at 12 months.

HSIL was present in the urethra without being able to define specific clinical criteria. Treatment with a CO₂ laser under colposcopy with a meatus spreader is a simple surgical procedure with high efficiency and few complications that could prevent the risk of HPV-induced carcinoma.