Treating Vaginal and External Anogenital Condylomas with Electrosurgery vs CO₂Laser Ablation

Abstract

Our objective was to assess the technical characteristics, side effects, complications, and effectiveness of electrosurgery vs continuous wave CO2 laser in the treatment of genital warts. This open clinical trial was made up of 208 evaluable patients (135 women and 73 men) with vaginal and external anogenital condylomas. To avoid selection bias, in each patient half of the lesions measuring 2 cm2 or greater total linear area were treated with loop electroexcision and ball electrofulguration, and the other half were treated with CO2 laser excision and vaporization in a continuous wave mode spot welding. All patients were followed for at least 6 months (maximum 18 months, mean 8 months) after the last treatment received. The average operative time was 6 min for electrosurgery and 8 min for laser. Healing was completed in 95% of patients with a lesional area of 5 cm2 or less and 100% of patients with 5 cm2 or larger by the third and sixth postoperative week, respectively. Severe discomfort occurred in 12% of patients, and 4% of patients developed delayed complications, including vitiligo and scarring, irrespective of treatment modalities used. Complete clearance of warts in women and men after a single (51% and 38%) and multiple (75% and 64%) treatments were similar in areas treated with electrosurgery and CO2 laser. Electrosurgery appears to be as effective as continuous wave CO2 laser for treating vaginal and external anogenital condylomas, particularly those limited to a 5 cm2 or less area.

CO₂ Laser Surgery for Extensive, Cauliflower-Like Anogenital Condylomata acuminata: Retrospective Long-Term Study on 19 HIV-Positive and 45 HIV-Negative Men

“…CO 2 laser surgery of CA is commonly accepted as equivalent to electrosurgery in terms of remission rates, as has been shown by Ferenczy et al [19]. In our experience, CO 2 laser surgery is particularly suitable in the exact ablation of endoanal CA.…”

“…The majority of large prospective studies rather report on cure rates of 32–43% after 1 session [16, 17]or up to 64% after several sessions [19], respectively. In a questionnaire-based retrospective study, satisfied patients tend to be overrepresented, and, therefore, treatment success may be overestimated.…”

“…More extensive and confluent lesions are commonly treated with high-frequency electrosurgery or CO 2 laser surgery. The reported healing rates reach 39–43% after 1 treatment session [16, 17]and 64% after repeated sessions [18, 19]. Several randomized controlled trials have investigated the impact of adjuvant interferon after surgical ablation of CA [20].…”

Ultrasonic Technology: A New Treatment Option for Anal Condylomata Acuminata

“…However, special training is required for the operation to avoid destruction beyond the dermal papillae, which may cause scarring in up to 28 percent of patients 17 and dyspigmentation, 18 especially in darkskinned individuals. 19 Other sequelae include recurrent anal fissures, perianal dermatitis, and prolonged painful defecations. 20 No such complications have occurred after Harmonic® Scalpel application.…”

Sexually transmitted papillomavirus infections: epidemiology pathogenesis, clinic, morphology, important differential diagnostic aspects, current diagnostic and treatment options

“…HPV DNA may be released during laser vaporization of genital HPV infected lesions; if appropriate evacuating equipment is used, contamination of the operator is unlikely. 63,64 The surgeon must wear laser masks and use a vacuum ventilation system. Risk factors for transmission of genital warts by vaporization are the HPV type, thickness of the skin, and viral burden.…”