Indications for urethroscopy in male patients with penile condylomata

Benson et al recommended that to detect condylomata, urethroscopy should be performed on the male partners of women with cervical dysplasia. Considering this, in April 1990 we began to perform urethroscopy on all of our patients who presented with genital condylomata. Between April 1990 and January 1993, 84 patients were referred for initial evaluation of condylomata. The penis, scrotum, perineum and perianal areas were inspected, and the penis was reinspected after staining with 5% acetic acid. Intraurethral condylomata were detected in 13 patients (15%), 11 of whom had visible lesions on physical examination with spreading of the meatus. Urethroscopy confirmed these lesions to be limited to the fossa navicularis. Two patients had lesions of the fossa not visible at the meatus. No patient in this series had lesions of the more proximal urethra. All patients eventually determined to have intraurethral lesions had external condylomata on the distal penis (glans, corona or frenulum). Using the presence of distal penile lesions as the criterion for urethroscopy, 30 patients (36%) would have undergone urethroscopy, including all 13 eventually diagnosed to have intraurethral condylomata, for a yield of 43%. A total of 54 patients (64%) who failed to meet this criterion would have been spared the procedure. Consideration of dysuria or urinalysis did not improve the yield. When evaluating male patients with genital condylomata, we recommend spreading the urethral meatus during the examination. Urethroscopy is indicated only for those with distal penile or meatal lesions.