The Clinical Research Of Photodynamics On Therapy Of Urethral Condylomata Acuminata

Objectives: Condylomata acuminata (CA) is one of the most common sexually transmitted diseases caused by human papillomavirus (HPV). The incidence of CA has been increasing year after year. There is still a high recurrent rate and adverse effects in patients with CA after conventional therapies. Topical photodynamic therapy (PDT) with 5-aminolaevulinic acid (ALA) is a promising attractive technique for the local treatment of CA, and promising results have been reported these years, especially for urethral CA. But the varied research group exist some differences in therapeutic schedule, including the dosage forms of ALA, ALA'density, dressing frequency,dressing times, et al. To explore better treatment schedule,we combine ALA solution and cream of low concentrations,reduce dressing time and numbers.Then observe the clinical efficacy and safety.Methods: A total of 108 patients with urethral condyloma were treated. A thin cotton swab was soaked in the 10% ALA solution and was gently inserted into the distal urethra at first, then the operation was repeated with 10% ALA cream after 30 min. Light irradiation was applied to the lesion after 3 h using a cylindrical helium–neon laser fibre emitting 635 nm laser light.Lesions size and shape was observed before treatment and the advers effects in treatment was recorded. If the warts were not totally removed after 1 week, a repeat treatment was given once a week for maximum of 6 weeks. The lesions were evaluated after each ALA-PDT treatment session. The follow-up was conducted each month after the treatment finished.Results: 104 cases of 108 patients (96.3%) with urethral condylomata acuminata achieved complete response after 1 to 6 treatments; a complete response was observed among 48 patients (44.4%) after first treatment. Among the 78 male patients, 76 cases (97.4%) achieved complete response after 1 to 6 treatments and 48 patients (61.55)recovered after first treatment.However , 28 cases of 30 female patients (93.3%) achieved complete response after 1 to 6 treatments and none recovered after first treatment. The efficacy of ALA-PDT for the urethral CA of male was superior to that of women. Follow-up for patients with complete response lasted for 12 months. Of these 104 patients, eight relapsing patients (7.69%) were found .All the warts were off during the third to fifth day after treatment. The treated area was back to normal during the fifth to tenth day. No systematic adverse reactions occurred. About half of the patients experienced a mild burning which can be tolerated during rradiation. Conclusion: The results confirm topical application of ALA-PDT in our treatment schedule is a simpler, more effective and safer therapy with a lower recurrence for treatment of urethral CA especially in male .