State of microcirculation in patients with genital condylomas of the anogenital area and characteristics of efficiency of treatment at the period of preoperation

Abstract

Introduction. Determination of the state of microcirculation in patients with genital warts (GW) of the anogenital area and the effectiveness of correction at the stage of preoperative treatment.  

The aim of the study. Determination of the state of microcirculation in patients with genital warts (GW) of the anogenital area and the effectiveness of correction at the stage of preoperative treatment.  

Materials and methods.  105 patients (63 – 60 % women; 42 – 40 % men) with genital warts with anogenital lesions were examined and treated: single acute warts – 36 (34,29 %); multiple acute warts – 66 (62,86 %); giant Bushke-Levenstein warts – 3 (2,86 %.). Control group consisted of 20 healthy people (women 10 – 50 %; men 10 – 50 %). Assessment of local circulatory status was determined by laser Doppler flowmetry with a wavelength of 0,63 μm (in the red range). The indicator of microcirculation (IM) – amplitude of oscillations of blood circulation in real time and its average value (M) were determined; standard deviation (SD) of the amplitude of blood flow fluctuations from the mean value of M; C_v – coefficient of variation - reflects the relationship between perfusion and its variability: C_v = σ / M×100 %

The examination was performed in two clinical groups during the initial examination, after 2 weeks of preoperative preparation and in the dynamics of observation in the postoperative period. All patients received immunomodulatory, antiviral and topical therapy for two weeks, which included antiseptic and hyaluronic acid. The first group included 70 patients who were prescribed Tivortin Aspartate (L-arginine Aspartate) 2 weeks before surgical treatment. The second group consisted of 35 patients and was comparative in monitoring the effectiveness of treatment.  

Results and Discussion. The state of microcirculation among healthy subjects was characterized by variability in the amplitude of oscillations with preserved active and passive regulatory mechanisms.  

In patients with single acute warts, blood circulation corresponded to the spastic form of disorders, which was characterized by: low amplitude of oscillations M – (4,60 ± 0,06) pf.un. (p < 0,05), decrease in SD – (0,56 ± 0,03) pf.un. (p < 0,05) and C_v – (12,23 ± 0,58) % (p > 0,05). Patients with multiple GW were characterized by a hyperemic type of microcirculation, which accompanies the inflammatory process and, but occurs due to decreased venous circulation:  M – n (12,29 ± 0,32) pf.un. (p < 0,05), SD – (0,66 ± 0,03) pf.un. (p < 0,05), C_v – (5,52 ± 0,22) % (p < 0,05). In patients with giant Bushke-Levenstein warts, changes in blood flow varied from hyperemic type with values of M – (18,92 ± 0,55) perfusion units (p < 0,05), SD – (0,55 ± 0,21) pf.un. (p < 0,05), C_v – (2,95 ± 1,17) % (p < 0,05); to stagnant in the combination of Bushke-Levenstein warts with necrosis and phlegmon of the perineum:  M – (19,81 ± 0,13) pf.un. (p < 0,05), SD – 0,40 pf.un., C_v – 2,0 %.

Positive changes in microcirculation at the end of preoperative preparation were more pronounced in the first group, where L-arginine aspartate was used, which was manifested in a significant increase in C_v, SD and variability of M.  

Conclusions. Changes in microcirculation in patients with acute genital warts of the anogenital area are realized in 3 variants: spastic – in patients with single GW, hyperemic - in patients with multiple GW, stagnant, which acquired maximum disorders in patients with giant Bushke-Levenstein warts.  

L-arginine has a positive effect on microcirculation in the focus, and regardless of the initial type (hyperemic or spastic, stagnant), contributes to its changes towards normalization. This efficiency can be explained from the standpoint of the direct effect of L-arginine as a nitrogen donor on the active mechanisms of regulation of microcirculation.  

Significant changes in microcirculation towards normalization with less pronounced positive dynamics in patients of the second clinical group, due to the indirect effect on the state of microcirculation due to the influence of systemic antiviral treatment, local therapy on the pathological process.