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Keywords:

  • human papillomavirus;
  • urethral condyloma acuminatum;
  • urethral instrumentation.

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Case report
  5. Discussion
  6. References

Abstract  A 70-year-old man had undergone urethral dilatation with bougie for 8 months following transurethral resection of the prostate and complained papillary masses at the urethral meatus. Physical and endoscopic examination revealed multiple tumors from the urethral meatus to the bulbous urethra. These tumors were resected transurethrally and 5-FU cream was instilled into urethra. Microscopic examination revealed urethral condyloma acuminata. Human papillomavirus types 6/11 were detected in the condylomas.

As high prevalence rate of genital human papillomavirus was reported in penile skin of healthy men, urethral instrumentation including transurethral surgery might cause dissemination of penile skin human papillomavirus into the urethral lumen.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Case report
  5. Discussion
  6. References

The prevalence of human papillomavirus (HPV) in male genitalia has not been paid attention, although a high prevalence of HPV is well known in women. Additionally, the incidence of urethral condyloma concerned with urethral instrumentation, including transurethral surgery, has not been reported.

We report a case of urethral condyloma following urethral instrumentation in an elderly man.

Case report

  1. Top of page
  2. Abstract
  3. Introduction
  4. Case report
  5. Discussion
  6. References

A 70-year-old man underwent transurethral resection of the prostate (TUR-P) due to benign prostatic hyperplasia on November 13th, 2000. The patient had not experienced sexual intercourse for a number of years before the TUR-P. There were no abnormal lesions in the external genitalia or the urethra during the operation. He had underwent urethral dilatation with bougie two months after the operation due to stenosis of navicular fossa. Urination gradually became worse, although the bougie was repeated several times. On May 10, 2001, papillary masses were observed at the urethral meatus. Physical examination revealed a cluster of masses at the urethral meatus, but no evidence at the external genitalia. Endoscopic examination revealed multiple tumors in the navicular fossa and bulbous urethra (Fig. 1). These masses were resected transurethrally on July 16, 2001. Microscopic examination revealed that the epithelial layer of papillary lesions consisted of well-ordered rows of squamous cells (Fig. 2a). A number of the epithelial cells were markedly vacuolated (Fig. 2b). Based on these findings, we diagnosed urethral condyloma acuminata. After the resection of condylomas, 5-fluorouracil (5-FU) cream had been instilled into urethra for two weeks. Repeated examination eight weeks after the initial treatment showed a small mucosal elevation and the lesion was treated with electro-coagulation and 5-FU instillation again. Using polymerase chain reaction techniques and in situ hybridization by SUMIKIN bioscience laboratory (SBS Inc., Tokyo, Japan), HPV types 6/11 were detected in the condylomas. At the time of writing, no recurrence has been seen.

image

Figure 1. Multiple condylomas were shown from the urethral meatus to the bulbous urethra. (a) Urethral meatus; (b) navicular fossa; (c) penile urethra; and (d) bulbous urethra.

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image

Figure 2. Microscopic findings of urethral condyloma acuminata. (a) The epithelial layer of papillary lesions consisted of well-ordered rows of squamous cells. HE × 100. (b) A number of the epithelial cells were markedly vacuolated (×400).

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Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Case report
  5. Discussion
  6. References

Urethral condyloma acuminata is due to the infection of HPV and is possibly disease among wide generations concerned with sexual activities. At present, almost 13–47% women are incidentally cervically HPV positive, although differences exist among countries and ages.1 In particular, the prevalence of HPV types 6 and 11 were 3% and 15%, respectively. In Japan, HPV types 6, 11, 16, 18, 31, 33 and 35 were present in 9.3% of women with normal cervixes.2

While the high prevalence of genital HPV in women is reported, there is little known regarding the prevalence in men. International Agency for Research on Cancer (IARC) investigators reported a high prevalence (3.5%−39.0%) of genital HPV in the penile skin of healthy men.3,4

Generally, retrograde urethral viral infection in men is likely to be difficult, owing to the mucosal immune system, even if the penile skin is exposed to genital HPV. However, it may be possible that HPV is disseminated into the urethra following urethral instrumentation. Zaak et al. also indicate a risk of viral infection by urethral instrumentation through the high recurrent rate (35.7%) following transurethral laser treatment.5 Likewise, HPV infection might be associated with urethral instrumentation due to TUR-P or repeated urethral bougie, rather than sexual transmission in the present case. Urethral condyloma acuminata should be noted in case of urethral instrumentation, including transurethral surgery.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Case report
  5. Discussion
  6. References