Venous malformation of the glans penis : "Every-5-mm" neodymium:yttrium-aluminum-garnet laser irradiation.

概要

Vascular anomalies of the male genitalia are rare with no consensus on classification, cause, and treatment(1). They include hemangiomas and vascular malformations. Hemangiomas are on the skin and may demonstrate significant growth after birth followed by slow involution. Vascular malformations are present at birth in the subcutaneous tissues and tend to persist or enlarge in adolescence(2).
Venous malformation(VM) is one of the slow-flow vascular malformations and affects the glans penis(2). VM of glans penis show soft, compressive, blue, endophytic, and/or exophytic masses, and are diagnosed by color Doppler ultrasonography, which shows dilated vein without pulsation. VMs change their size during erection and detumescence. Patients are very sensitive to this, and considerable distress and loss of self-esteem can result(1). The main reason for seeking medical treatment is cosmesis to correct these deformities and restore a normal-looking penis without compromising anatomical integrity and functional ability.
The glans penis consists of squamous epithelium, lamina propria, and corpus spongiosum. The lamina propria has a 1-3-mm thick connective tissue layer containing vessels, lymphatics, and nerves. The corpus spongiosum consists of an 8-10-mm thick layer of erectile tissue with vessels, smooth muscle, and nerves(3). Although VM of the glans penis arises from lamina propria and corpus spongiosum just underneath the epithelium. It is important to remove or collapse VM to keep the surface of the glans penis smooth. Generally, treatment of vascular malformations requires sclerotherapy and/or surgical excision in the specialty center of vascular anomalies(1). Sclerotherapy usually needs multiple sessions with or without radiation(4). If they are multiple and or endophytic, microsurgical excision with glanuloplasty and urethral meatoplasty requires to reserve the smooth surface of the glans penis(5). Additionally, the neodymium: yttrium-aluminum-garnet (Nd-YAG) laser is reported a good candidate to treat this condition. This laser emits light at 1064 nm and ablates deeper lesions in various organs. In 1993, Jimenez-Cruz reported the first case to treat VM of the glans penis successfully using Nd-YAG laser, which offers tissue penetration to about 5 mm and can coagulate and collapse deep vascular lesions(6).
Since there are small case series reporting excellent cosmetic results without relapse in the long term, there is no technical guide regarding VM ablation by Nd-YAG laser(7).
Between 2011 and 2019, Nd-YAG laser treatment was done for six adolescent and young adult patients aged mean 164(11-22) with VM of the glans penis. All of the patients complained of deformity of the glans penis during erection and desired its surgical correction. To project Nd-YAG laser energy into the VM homogeneously, and to shrink the mass uniformly, we developed a novel protocol to irradiate the target at spots 5 mm apart from one another.

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