Genital lesions are a relatively common condition which may be caused either by sexually transmitted human papillomavirus (HPV) infection, as a result of non–infectious inflammatory diseases such as psoriasis and lichen planus, by a drug reaction and also as premalignant lesions that can progress to carcinoma. Regardless of origin, genital lesions are both a source of considerable discomfort and a cause of embarrassment and psychological repercussions. Genital lesions can often persist for prolonged periods, frequently a number of years and can re–occur after treatment.
Genital warts caused by HPV are the most common sexually transmitted disease and a major cause of anogential lesions. In addition to physical and psychological implications of HPV warts, there is also a substantial economic cost, estimated at $6 billion annually in the United States . No specific antiviral therapies are available to cure HPV anogenital warts; treatment therefore relies on removal of warts or limiting spread through anti-proliferative or immunomodulation therapy . However recurrence rates can be high due to the widespread infection or subclinical lesions that are not identified at the time of treatment. The variety of different treatment options for genital warts can be loosely grouped into three categories: topical agents, systemic agents, and surgical therapies .
One surgical therapy that is showing increasing use across dermatological conditions is diode laser therapy. Diode lasers are semiconductors that change electrical energy into light energy through the use of solid‑state elements, such as aluminum and gallium. The light beam which is released by the diode laser falls within the visible and invisible range of near infrared waves (with wavelengths varying between 800 and 980 nm) and is able to vaporize soft tissue due to its high water content. These light beams are poorly absorbed by the hard tissue and therefore do not damage nearby hard tissue. By focussing the beam on the desired area for incision, a highly precise focal spot can be created. By adjusting the focus of the beam, the intensity of the laser light can be varied, which allows cauterization of small blood vessels and lymphatics to decrease post–operative swellings and sealing of nerve endings to reduce post-operative pain [3-5]. Studies suggest that side effects of diode laser therapy are generally mild [6-9]. However laser therapy can be expensive and is not widely available. Research to determine the efficacy of laser therapy for the treatment of different conditions is therefore important in order to justify investment in laser equipment and training in the use of laser therapy.
Laser therapy has been shown to be effective in a number of conditions, with probably the largest body of work conducted to examine the efficacy of laser surgery for the removal of different oral lesions such as simple soft tissue surgery (e.g. frenectomy, gingival contouring plasty) [3,10-12], vascular lesions (e.g. hemangiomas, telangiectasias) [4,5] and pigmented lesions . Other areas where lasers have become a key option for treatment include cosmetic applications such as laser hair removal and laser tattoo removal, and various dermatological applications, including conditions such as syringoma, xanthelasma palpebrarum, recalcitrant warts, rhinophyma, epidermal nevi, condyloma and intraepithelial neoplasia and milia [13-19]. These studies have suggested a number of advantages of laser surgery over traditional scalpel surgical procedures, such as greater precision, a relatively bloodless surgical and postsurgical course, sterilization of the surgical area, minimal swelling and scarring, coagulation, vaporization, cutting, minimal or no suturing, and less or no postsurgical pain .
There have been few studies to date that have examined the efficacy of laser therapy as a destructive therapy for genital warts [20-23]. Because warts are vascular, laser therapy should result in instant coagulation and therefore provide bloodless removal of the lesion. The few studies of genital lesions conducted to date suggest clearance rates ranging between 23% and 52% for carbon dioxide and pulse dye laser therapy; however recurrence rates as high as 77% have also been reported [19,20,22]. However, the description of the use of laser diode vaporization in urological applications is still limited, and further work is required to fully understand the effectiveness of laser diode vaporization as a treatment for various urological conditions. The aim of this study was therefore to evaluate the efficacy of diode laser vaporization treatment in genital lesions.