GUM specialist services to treat complex HPV-related diseases unresponsive to conventional therapies are limited. Laser vaporisation following local anaesthesia is an established treatment for refractory warts and intraepithelial neoplasia. Several service specifications have called for these treatments to be delivered and funded outside of Level 3 GUM clinics. A specialist Laser Clinic was established within our centre in 2015. A specially trained clinician reviews individuals. Where the diagnosis is unclear, biopsies are performed. CO2 laser vaporisation is instituted following application of local anaesthesia. Post-operative pain relief is provided and attendees are asked to follow a post-laser pain control algorithm. All attendees are asked to complete a feedback form.Methods
The case notes and patient feedback of all attendees to the Laser Clinic were reviewed.Results
155 unique patients have been seen since January 2015. 134 laser procedures have been performed with no evidence of recurrence or reinfection. Diagnosed cases of ano-genital intraepithelial neoplasia: PIN: 14, AIN: 24, VIN: 7 (45/134).Results
100% of attendees rated the service as excellent or good, with 95% stating that their pain was controlled throughout the procedure.Discussion
30% of attendees were found to have intraepithelial neoplasia. Encouraging patient feedback, high rates of pathology and positive post-operative outcomes with no evidence of recurrence demonstrate that laser therapy is a valuable treatment option, avoiding the need for onward referral, general anaesthetic and more costly procedures outside of the GUM setting. This service illustrates the importance of maintaining complex service delivery within the GUM setting.