Pulsed KTP Laser Coagulation of Submucosal Telangiectatic Vessels in Patients with Radiation Cystitis
Shahin Tabatabaei, MD, Sarah D. Psutka, M.D., Mohammad M. Siddiqui, M.D., W. Scott McDougal, M.D..
Massachusetts General Hospital, Boston, MA, USA.
BACKGROUND: Hemorrhagic cystitis is a debilitating complication of radiation therapy for pelvic malignancy. We report our 4 years experience using a KTP laser (532 nm, Greenlight™) to treat radiation induced hemorrhagic cystitis.
METHODS: Between September 2004 to December 2008, 18 patients with intractable hematuria underwent endoscopic KTP laser photoselective coagulation of submucosal telangiectatic, hemorrhagic vessels of the bladder under general anesthesia. The laser setting was kept at 2-30 W with a pulse duration of 40 ms to 100 ms. With the use of low power short laser pulses and selective absorption of laser energy by the hemoglobin, the submucosal telangiectatic vessels were coagulated, without damaging the overlying mucosa.
RESULTS: Control of bleeding was achieved in 13 patients after one session and in 4 patients after two sessions of laser treatment. One patient continued to bleed despite all efforts and ultimately underwent urinary diversion. There were no complications of the procedure and recurrence of significant bleeding was not seen in any of the resondants. Mean follow-up period of 22 months (range 4-51 months)
CONCLUSIONS: Our experience suggests that KTP laser is effective in treating refractory hemorrhagic radiation cystitis and can be safely applied to this patient population. Minimal damage to the mucosa and therefore decreased risk of bladder mucosal scarring and fibrosis make this approach superior to electrocoagulation. We recommend laser treatment be considered in patients with hemorrhagic radiation cystitis as a first line of therapy.