V02-02: Green Light Laser for management of haemorrhergic cystitis – technique and initial results.
Chronic haemorrhagic cystits occurs in approximately 5% of patients following pelvic radiotherapy & is associated with a 44% mortality rate despite definitive urinary diversion and cystectomy. Classic management options include bladder washout, intravesical allum or formalin, hyperbaric oxygenation & other systemic therapies all of which have variable results. GreenLight laser boasts the advantage of selectively ablating blood vessels via absorption of selective light waves. The waves reside within the same spectrum as intravascular oxy-haemoglobin and thus destruction is tissue specific & spares surrounding structures. This minimizes risk of bladder perforation & carries with it the benefit of immediate control of bladder haemorrhage. We describe our novel technique & initial results of 12 patients.
A retrospective audit of theatre records of a single surgeon was performed. Technique: Rigid cystoscopy was performed to assess degree of haemorrhergic cystitis & identify anatomical landmarks. Bilateral open ended 5Fr ureteric catheters were placed to allow identification of the ureteric orifices during the procedure. The laser was set to 80 vaporisation & 30 coagulation, with active bleeding sites targeted first to optimise vision. Lasering was then commenced within the four quadrants of the bladder in a systematic fashion using the vaporize function. Sweep speed of 80 sweeps per minute & a sweep angle of approximately 65 degrees was utilised. Ureteric catheters remained in situ for 24h. Using a large bore cannula, the distal end of a 18Fr Foley indwelling urethral catheter was created to allow passage of the ureteric catheters into the lumen and urine collection bag. Continuous bladder irrigation (CBI) was utilised overnight. When urine output was clear CBI was ceased & patients were observed for 6 hours. Uretetric and Foley catheters were removed prior to the 24hour mark to minimise inflammation secondary to foreign body.
12 patients were identified. 8 previously required blood transfusion secondary to bladder haemorrhage. 9 patients were successfully treated & 2 patients saw improvement in haematuria but required repeat procedure at 3 weeks post operatively. 4 patients went on to receive hyperbaric oxygenation as consolidative therapy. 1 patient was unsuccessfully treated and went on to cystectomy. There were no mortalities. No patients sustained bladder perforation or damage to surrounding structures.
We present an alternate technique using green light laser to ablate the bladder mucosa, with good results. The procedure may need to be repeated at 3 weeks if persistent bleeding occurs otherwise consolidation with hyperbaric oxygen therapy may be considered. The initial results are promising however further prospective evaluation with a larger cohort would enable better evaluation of this technique as a definitive management option for haemorrhagic cystitis.