Zaitcev A., Pushkar P.. Diyakov V, Galchikov I.
MSMSU, Urology, Moscow, Russia
Eur. Urol. Suppl., v.5(2) Apr. 2006: 194

INTRODUCTION & OBJECTIVES: We studied efficacy of endovesical ablation with Ho:YAG-laser in patients with various forms of chronic cystitis.

MATERIAL & METHODS: 48 women (mean age 34.5) with chronic cystitis refractory to other treatments underwent endovesical therapy with a Ho:YAG-laser. Patients were divided into 3 groups: group 1 - 19 patients (39.6%) with urothelium proliferative changes, group 2 - 7 patients (14.6%) with bladder neck pseudopolyposis, and group 3 - 22 patients (45.8%) with the Hunner's ulcers. We used a STN-10 apparatus with a power of 20 W, energy of 3 J. and wavelength of 2,100 nm. Cystoscopy was performed under general anaesthesia, with a 600-microne laser fibre inserted into the bladder through the cystoscope. The ablation was performed under visual control with impulses of up to 15 Hz and impulse duration of 600 milliseconds. No adverse events were observed. The bladder was drained for 24 hr. A follow-up evaluation was performed at 6 and 12 mo. The measures of efficacy were changes from baseline in pain and urgency (100 mm visual analog scales), 24-hr frequency and functional bladder capacity (48-hr voiding log). Symptom severity regarding pain and voiding problems was checked using the validated, self-administered 1 symptom and problem index (ICSI). Bladder biopsy specimens were available from all patients at baseline.

RESULTS: Urinary frequency decreased in all responders. The 24-hr voiding frequency decreased from a range of 15 - 22 to a range of 6 - 11 voids per day at 6 months follow-up. Nocturia decreased from a range of 2.0 - 5.5 night time voids to a range of 0 - 1.5 voids. Functional bladder capacity changed from 56 - 149 ml to 150 - 220 ml. A pain scale improvement was from a range of 20 - 96 mm at baseline to 4 - 30 mm and an urgency scale improvement from 49 - 92 mm to 3 - 40 mm at 6-12 months follow-up. The symptom and problem index score decreased from a range of 22 - 34 points to 3 - 16 points. Data analysis of the lst group showed good efficacy in 14 out of 19 (73.7%) patients; in the 2-nd group was considered effective in 100% of cases; and in the 3-rd group good results were achieved in 18 out of 22 patients (81.8%). Symptoms recurred rapidly (mean 9.2 weeks) in 4 patients with Hunner's ulcers. Repeat laser ablation resulted in sustained symptom improvement.

CONCLUSIONS: Ho:YAG laser endovesical ablation of urothelium areas with pronounced proliferative changes and/or the presence of Hunner's ulcers is an effective additional method in the treatment of recurrent cystitis. Laser ablation of Hunner's ulcer appears to be excellent treatment option in this most severe form of interstitial cystitis. Ho:YAG endovesical ablation with a laser of affected areas of the bladder resulted in a significant reduction of symptoms of the disease and improvement of the quality of life of the patients by 1.5 - 2 times.