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A Case of Primary Urethral Condyloma Acuminatum after Urethral Instrumentation/Uretral Ensturumantasyon Sonrasi Primer Uretral Kondiloma Akuminata Olgusu.

Abstract

A 72-year-old male with a history of transurethral resection of the prostate one year prior to admission and internal urethrotomy for a urethral stricture three months prior presented with obstructive lower urinary tract symptoms. An endoscopic investigation of the patient revealed widespread papillary formations throughout the urethra. With no pathologies found during cystoscopy of the bladder, the patient underwent transurethral resection and laser vaporization for urethral lesions. Microscopic investigation results revealed condyloma acuminata. In the literature, different cases of urethral condyloma acuminata have been reported. On first encountering urethral condyloma acuminata, the clinician may easily confuse it with papillary urothelial cancer. Our patient did not have genital lesions and was not sexually active. He only had a history of urethral instrumentation, which was of note given that widespread lesions had developed in a short period of time.

Keywords: Condylomata acuminata, urethra, transurethral resection, laser therapy

Oz

1 yil once Prostat Transurethral Rezeksiyonu (TUR-P) ve 3 ay once uretra darligi nedeniyle internal uretrotomi oykusu olan 72 yasinda erkek hasta obstruktif alt uriner sistem semptomlari ile klinigimize basvurdu. Hastanin endoskopik incelemede tum uretrada yaygin papiller olusumlar gozlendi. Sistoskopide mesanede patolojik olusum saptanmayan hastanin uretral lezyonlarina Trans Uretral Rezeksiyon ve lazer ile vaporizasyon uygulandi. Mikroskobik inceleme sonucu kondiloma akuminata olarak saptandi. Literatur incelendiginde farkli urethral kondiloma akuminata vakalari bildirilmektedir. Ilk defa urethral kondiloma akuminata ile karsilasan hekim tarafindan kolaylikla papiller uretelyal kanser ile karistirilabilir. Bizim olgumuzda ek olarak; hastamizda genital lezyon bulunmamasi, seksuel aktif olmamasi, sadece uretral enstrumantasyon oykusu olmasi ve kisa surede tum uretrayi tutan yaygin lezyonlar ile basvurmasi olgumuzu ilginc kilmaktadir.

Anahtar Kelimeler: Kondiloma akuminata, uretra, transuretral rezeksiyon, lazer tedavisi

INTRODUCTION

Human papillomavirus (HPV) has an etiological role in the development of cervical cancer in addition to the development oral cavity carcinomas, laryngeal carcinomas, penile and anal cancers (1-3). More common than these cancers, HPV causes the development of genital condyloma acuminata with subclinical progression. Genital condyloma acuminata are generally observed on the skin, external meatus, and rarely observed in the proximal urethra (4). Though HPV causing genital condyloma acuminata is generally transmitted by sexual routes, we aimed to present a case of primary urethral condylomata acuminata involving the entire urethra, which is different from many cases in the literature, in a patient with no risk factors identified after transurethral resection of the prostate (TUR-P).

CASE PRESENTATION

A 72-year-old male presented with obstructive urinary tract symptoms that had persisted for one month. A clinical history of the patient revealed that he had undergone TUR-P for benign prostatic hyperplasia one year prior to admission and internal urethrotomy for a urethral stricture three months before. Cystoscopy of the patient revealed papillary formations beginning at the distal urethra and extending to the neck of the bladder (Figure 1, 2). It did not reveal any pathology in the bladder. Following this, transurethral resection (TUR) was performed for large papillary tumoral lesions in the urethra, with laser vaporization of small lesions (Figure 3). Pathology results were in accordance with condyloma acuminata (Figure 4). From the patient's history, information was obtained, indicating that sexual relations had not occurred within the past two years. From surgical records, urethral lesions had not been identified during the previous two operations. A physical examination identified no lesion in the external genital region. Additionally, the patient had no immunosuppression finding in his clinical history or in his laboratory test results.

DISCUSSION

Condyloma acuminata are lesions formed by HPV, which is generally transmitted by sexual routes. Urethral condyloma acuminata are rarely observed and generally accompany genital condyloma acuminata (2, 3). Frequently, they are identified in the proximal penile urethra and as a single lesion (4). Contrary to this general information related to condyloma acuminata, our patient did not have condyloma acuminata in the genital region. The patient was not sexually active and only had a history of transurethral instrumentation, which made our case interesting. There are very few reports in the literature on primary urethral condyloma acuminata after urethral intervention in patients with no sexual history. Iskander et al. (5) reported that primary urethral condyloma acuminata developed during follow-up in a patient with a history of urinary tract instrumentation who was monitored for bladder cancer. However, in that patient, lesions were suitable for laser ablation. In our patient, lesions were widespread throughout the urethra. Sumino et al. (6) reported the development of urethral condyloma acuminata in the year following TUR-P in one patient. However, when the patient was questioned further, the authors found a previous history of condyloma acuminata. Irrespective of the difficulty of retrograde urethral viral infections to develop in males, Zaak et al. (7) stated that urethral instrumentation may ease this development.

Laser vaporization is recommended for treatment due to the lower risk of a urethral stricture. For widespread lesions, 5-fluorouracil (5-FU) for five weeks with two instillations per week is recommended. There are publications reporting full eradication with 18 doses of 5-FU treatment in immunosuppressed patients without surgical intervention. For urethral condyloma identified in a 43-year old patient with Acquired Immune Deficiency Syndrome (AIDS) and obstructive urination symptoms, Wen et al. (3) reported the full eradication of urethral lesions with 18 weeks of 5-FU treatment. As our patient was not compliant and did not want the five-week instillation treatment, TUR was carefully performed for urethral lesions and laser vaporization was performed for small lesions. With all identified lesions either resected or vaporized, our patient did not attend check-ups after the initial treatment.

CONCLUSION

Urethral condyloma acuminatum is an important pathology that may be easily confused with papillary urothelial cancer by clinicians in the first encounter. Our case stands out as the patient did not have genital lesions, was not sexually active, only had a history of urethral instrumentation, and presented with widespread lesions throughout the urethra that had developed in a short period of time.

The patient could not be reached using their contact details during the writing and revision of this case report. Additionally the patient did not attend check-ups during this time. Therefore, the patient was unable to receive the consent from.

Informed Consent: Written informed consent couldn't be obtained due to impossibility of reaching the patient.

Peer-review: Externally peer-reviewed.

Author contributions: Concept - L.I., M.A., C.M.; Design - L.I., A.B., H.A.; Supervision - L.I., M.A., H.A.; Resource - L.I., C.M., H.A.; Materials - L.I., E.A., H.A.; Data Collection and/or Processing - L.I., E.A., H.A.; Analysis and/or Interpretation L.I., M.A., A.B.; Literature Search - L.I., C.M., H.A.; Writing - L.I., M.A., H.A.; Critical Reviews - L.I., M.A., H.A.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study has received no financial support.

Hasta Onami: Hastaya ulasilamadigi icin yazili hasta onami alinamamistir.

Hakem Degerlendirmesi: Dis Bagimsiz.

Yazar Katkilari: Fikir- L.I., M.A., C.M.; Tasarim - L.I., A.B., H.A.; Denetleme - L.I., M.A., H.A.; Kaynaklar - L.I., C.M., H.A.; Malzemeler - L.I., E.A., H.A.; Veri Toplanmasi ve/veya islemesi - L.I., E.A., H.A.; Analiz ve/veya Yorum - L.I., M.A., A.B.; Literatur taramasi - L.I., C.M., H.A.; Yaziyi Yazan - L.I., M.A., H.A.; Elestirel Inceleme - L.I., M.A., H.A.

Cikar Catismasi: Yazarlar cikar catismasi bildirmemislerdir.

Finansal Destek: Yazarlar bu calisma icin finansal destek almadiklarini beyan etmislerdir.

REFERENCES

(1.) zur Hausen H. Papillomavirus infections--a major cause of human cancers. Biochim Biophys Acta 1996; 1288: F55-78. [CrossRef]

(2.) Culp OS, Magid MA, Kaplan IW. Podophyllin treatment of condylomata acuminata. J Urol 1944; 51: 655-9.

(3.) Wen YC, Wu HH, Chen KK. Pan-urethral wart treated with 5-fluorouracil intraurethral instillation. J Chin Med Assoc 2006; 69: 391-2. [CrossRef]

(4.) Rothman I, Berger RE, Kiviat N, Navarro AL, Remington ML. Urethral meatal warts in men: results of urethroscopy and biopsy. J Urol 1994; 151: 875-7.

(5.) Iskander M, Patrick N, Mistry R. Intra urethral human papillomavirus related warts following urinary tract instrumentation. Urol J 2014; 11: 1491.

(6.) Sumino Y, Mimata H, Nomura Y. Urethral condyloma acuminata following urethral instrumentation in an elderly man. Int J Urol 2004; 11: 928-30. [CrossRef]

(7.) Zaak D, Hofstetter A, Frimberger D. Schneede P. Recurrence of condylomata acuminata of the urethra after conventional and fluorescence-controlled Nd: YAG laser treatment. Urology 2003; 61: 1011-5.[CrossRef]

Lokman Irkilata (1), Mustafa Aydin (1), Alper Bitkin (1), Ebubekir Akgunes (1), Caner Moral (1), Hulya Akpinar (2)

(1) Department of Urology, University of Health Science, Samsun Training and Research Hospital, Samsun, Turkey

(2) Department of Pathology, University of Health Science, Samsun Training and Research Hospital, Samsun, Turkey

This study was presented at the 12th International Urooncology Congress, 18-22 November 2015, Belek, Antalya.

Bu calisma 12. Uluslararasi Uroonkoloji Kongresi'nde sunulmustur, 18-22 Kasim 2015, Belek, Antalya.

Correspondence Author/Sorumlu Yazar: Lokman Irkilata E-mail/E-posta: irkilatamd@gmail.com

Received/Gelis Tarihi: 04.04.2016 Accepted/Kabul Tarihi: 20.09.2016 Available Online Date/Cevrimici Yayin Tarihi: 22.02.2017 DOI: 10.5152/clinexphealthsci.2017.32
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Title Annotation:Case Report / Olgu Sunumu
Author:Irkilata, Lokman; Aydin, Mustafa; Bitkin, Alper; Akgunes, Ebubekir; Moral, Caner; Akpinar, Hulya
Publication:Clinical and Experimental Health Sciences
Article Type:Case study
Geographic Code:7TURK
Date:Jun 1, 2017
Words:1534
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