as a urologist i see a lot of patient with growths or bumps on the penis

some patients ask do I have cancer? do I need a biopsy? 

Most patients with a classic wart or HPV do not need a biopsy, patient who are uncircumcised or recurrent growths may consider a biopsy.

Freezing a wart with liquid nitrogen, cauterization, or topical treatments like aldara (imiquimod topical cream)

if you have a wart get to a doctor and have it treated.  A biopsy is not a  bad idea but no always necessary

thanks for all of stories and questions I hope this site can help you fight your personal war on warts. 

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Penile warts are diagnosis that a trained doctor can make without a biopsy.  If patients have many warts or ones that look suspicious for other lesions like cancer I often biopsy a representative sample and freeze (with liquid nitrogen) or burn (electrocautery) or laser (C02 or YAG) the rest.  If a patient has warts on the foreskin and wants a circumcision I sent the tissue for biopsy. 

If your doctor didn’t send a biopsy and it didn’t come back that’s fine.  If it keeps coming back and there was never a biopsy ask your doctor to sent a piece to the lab or make sure they are convinced its not cancer.

I hope this post is helpful.  Go to our find a physician tab if you need an evaluation

Thanks,

Dr. A.

Treating penile warts presents several problems to the patient and to the treating physician.  The ideal treatment would be non-invasive, non disfiguring, quick, painless and it would eliminate the risk of any wart recurrence.

The ideal treatment does not exist.

Most treatments offer some sort of balance between expedience, invasiveness, and recurrence.  The correct treatment really depends on patient preferences, patient medical history, and the doctor’s experience.

Treatment options include:

• Imiquimod: This is a form of immunotherapy.  Is not invasive and non-disfiguring but requires 16 weeks of therapy.  Dermatologists seem to like to use it, but urologists like Dr Schoor, who have had extensive experience with imiquimod, have not found it useful for his male wart patients.
• Podophylin: This is another form of immunotherapy.  Like imiquimod, it is non-invasive and non-scar producing.  Podophylin takes approximately 4 weeks to work and is very effective on penile condylomas.  Recurrence rates are low with this approach.
• Cryo therapy: This means freezing off the warts, usually with liquid nitrogen.  This is a great treatment that effectively gets rid of the lesions without scar formation or marks and has very low recurrence rates.  It is painful and requires at least 3 to 4 applications over a 6 to 8 week period.  Dermatologists like this form of treatment for their patients.  Urologists don’t too so much of it, however.
• Cautery: Effective though invasive and scar producing.  It does require that the doctor give a local aneshtetic prior to the procedure.  Recurrence rates are higher than for the other treatments, but the results are immediate.  Perhaps the worst aspect of this approach is that the cautery smoke may contain vaprized though live viral particles that can be inhaled by patient and staff alike.  To prevent this occurrence, special masks may be worn.
• Excision: 100% effective but 50% or greater recurrence risks when used alone.  It does leave a scar but the result is immediate, which most men want.  Another advantage is that it allows for pathologic confirmation of the lesion, which on rare occasion can be a penile veru
  

  Using crythherapy to treat disease

  cous cancer.  Recurrence risks can be minimized by cauterizing or freezing the base after the excision or by having the patient apply podophylin or imiquimod after the wart has been removed.

• Laser therapy: This procedure is done in the OR with a CO2 laser.  It is very effective over the short and long term, non-scar forming, and immediate.  It is very expensive and best reserved for patients with extensive disease, such as in the immunoscompromised population.

We hope readers find this useful.

My wart schpeel
I see a fair number patient consults for “rule-out HPV” or “rule-out warts.”  The typical scenario is the following:

A woman goes to her gynecologist for a routine Pap smear and is told that the results came back positive for HPV.  She is then told by her doctor to have her male partner “checked-out.”
What does all that mean and what really happened at that patient’s doctor visit?

In a nutshell, the American College of Ob-Gyn recommends that women get periodic Par smears since Pap smears can detect cervical cancer early, and this saves lives.  Pap smears can also detect other disorders such as yeast infections and HPV infections.  HPV is the virus that causes genital warts.  On a Pap smear, the HPV virus produces cells with a characteristic look that most medical students would easily recognize.  That finding is called a Koilocyte.  When a Pap test shows Koilocytes, it indicates that the woman has been exposed to the HPV virus.

So what?

HPV is what is known as a ubiquitous virus.  This means that everyone—and their mothers—has been exposed to it at some point in their lives.  Most people just don’t know it.  The HPV virus family has many strains—more than 400.  Some strains cause genital warts.  Some strains cause Pap smear changes on women.  Some strains cause penile cancer while other strains cause cervical cancer.  Some strains cause warts on the ankles of young children.  And still, some strains don’t do anything that we can detect or that cause problems.

Here is the real interesting part about the HPV virus.  It exhibits a characteristic called tropism.
TROPISM

Tropism is a feature of many viruses.  It means that a specific virus can only attack and cause damage to a specific target, such as a cell in the cervix or on the ankle or a blood cell.  HIV has tropism for CD-4 blood cells.  HPV has tropism also.  Some strains will only cause problems on the ankle while other strains will only cause penile warts.  Other strains will only cause Koilocyte changes on a Pap smear while a different strain will cause cervical cancer.

Clinically this means that when a woman has a positive Pap test, it does not mean that the man necessarily infected her with the virus or that the man has a penile wart.  It does not mean that he did not do so either.  It just means that the virus strain that caused the Pap findings may not be the same strain that would cause a penile wart on the man.  It also means that the man should be evaluated for the presence of any lesions or warts on his penis.

Does that mean that you will always need to use a condom.  I tell my patients that there are many good and important reasons to use condoms, especially with new or not well known partners, but that HPV prevention is among the least important of those reasons.  Condoms can help prevent the transmission of HPV virus but not necessarily.  HPV can be transmitted in semen, but also is other body fluids.  The best way to prevent transmission of HPV is abstinence or to keep the number of sexual partners to a minimum.  Barring those 2 strategies, HPV infection will definitely occur.  Whether you develop problems from HPV depends on your own immune system and the viral strain with which you have been infected.