Laser Therapy

Laser treatment has been utilized in the treatment of penile carcinoma. It may be carried out in the outpatient setting, and has the additional advantage of producing excellent cosmetic and functional results. Carbon dioxide (CO2) and Neodymium:YAG (Nd:YAG) are the most commonly used lasers. The main difference between these is their penetration potential: CO2 laser has a longer wavelength (10,600 nm vs. 1,064 nm) and does not penetrate human tissues compared to Nd:YAG. A depth of 4-6 mm can be achieved with the Nd:YAG laser, but any tumor invading to greater than 6 mm is unsuitable for laser surgery. Assessment of tumor depth before starting laser treatment is therefore essential. This can be either accomplished with a biopsy or with ultrasound or magnetic resonance imaging (MRI). All of these modalities have limitations and run the risk of understaging the primary lesion.

Table 6.2 Local recurrence post laser therapy

Local

Mean

recurrence

Salvage surgery

follow-up

Author(s)

Laser type

Patient no

no (%)

procedures

(months)

Bandieramonte et al.23

C02

224

32(14.2)

23PPS/8PP/1TP

66

118 (T1-2)

12(11.3)

Tietjen and Malek24

C02/Nd:YAG

44 (T1-2)

5(11.4)

3PPS/2PP

58

Windahl and

C0/Nd:YAG

61

13 (19)

11PPS/2PP

42

Andersson25

4รณ (T1-3)

10(21.1)

PPS penile-preserving surgery, PP partial penectomy, TP total penectomy

PPS penile-preserving surgery, PP partial penectomy, TP total penectomy

Several studies support the use of laser in penile carcinoma. In 1995 Windhal reported the treatment of 19 patients, eight managed with CO2 laser alone and 11 with both CO2 and Nd:YAG. They reported two recurrences (11%) which were salvageable with further laser therapy. Both patients were disease free at 12 and 52 months.20 Shirahana and colleagues demonstrated the importance of case selection.21 They selected patients with carcinomas less than 6 mm thick, based on MRI and ultrasound scan assessments. Ten cases of CIS or stage T1 penile carcinoma were free of disease at 6 years. Two cases of stage T2 penile carcinoma were also included in this series. These were treated aggressively with a combination of chemoradiation and adjuvant laser therapy. Both were free of disease at 7 and 8 years of follow-up, respectively.

More recently, Meijer and colleagues applied laser therapy to 44 tumors ranging from Tis to T2 disease and reported a local recurrence rate of 48% overall. Twenty three percent progressed during follow-up to develop nodal disease, 80% of these having originally presented with T2 disease. This study confirmed the benefit of laser therapy in low-stage disease and highlighted the danger of disease progression in higher stage cases where laser therapy is unsuitable.22

Overall, as with any organ-preserving therapy, local recurrences are higher than with conventional surgery and close follow-up is essential to allow early detection and intervention without compromising the patients' survival (Table 6.2). Patient selection is also very important with late stage disease tending to be resistant to laser monotherapy. Complications of this treatment modality occur in 1-7% and include bleeding, moderate pain, and preputial lymphoedema.23-25 The long healing period is a further disadvantage of laser therapy.

Dealing With Erectile Dysfunction

Dealing With Erectile Dysfunction

Whether you call it erectile dysfunction, ED, impotence, or any number of slang terms, erection problems are something many men have to face during the course of their lifetimes.

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