Managing intrameatal and frenular warts in hypospadias: A conservative yet effective approach

Sir,

We present the case of a 28-year-old male with megameatus intact prepuce hypospadias who developed intrameatal and frenular genital warts. The patient reported dysuria and discomfort associated with a gradually enlarging, rough, wart-like lesion at the urethral opening over the past 2 months. On examination, an exophytic wart was observed within the urethral meatus, with an additional lesion present near the frenulum [Figure 1]. It is noteworthy that the incidence of hypospadias is approximately 3% in urology clinics versus 25% in sexually transmitted infection clinics, attributed to the absence of a protective squamous epithelium in hypospadias, which predisposes the vulnerable columnar epithelium to infections such as human papillomavirus (HPV).[1]

Figure 1.

Pre-treatment image showing verrucous warts located intrameatally and near the frenulum

Given the delicate anatomical location and the risk of meatal stenosis, conventional surgical excision was avoided. Instead, we employed a conservative treatment strategy utilizing radiofrequency ablation (RFA), followed by application of 100% trichloroacetic acid (TCA) at 2-week intervals for a total of four sessions. RFA facilitated precise ablation of the wart tissue, whereas TCA was applied to manage residual lesions. This combined modality resulted in complete lesion clearance without any scarring or compromise of urethral patency; the patient remained recurrence free at 3 months of follow-up [Figure 2].[2]

Figure 2.

Post-treatment image demonstrating complete resolution after four sessions of RFA and 100% TCA application

Genital warts in patients with hypospadias are uncommon and pose unique management challenges. Conservative modalities that preserve urethral integrity, such as the combined use of RFA and TCA, offer a viable alternative to more invasive procedures that may carry higher risks of complications.[3] Our case underscores the importance of individualized treatment strategies in patients with anatomical variations predisposing them to persistent HPV infection and wart formation. Further studies are warranted to establish optimal management protocols in this subgroup of patients.

We believe that this report adds valuable insight to the literature on the conservative management of intrameatal and frenular warts in hypospadias and emphasizes the role of minimally invasive interventions in preserving urethral function.

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The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.