Photoselective Vaporisation of the Bladder for the Management of Radiation Cystitis - Technique and Initial Outcomes.

Abstract

Objective To describe our technique utilising photoselective vaporisation of the bladder (PVB) for the management of haemorrhagic cystitis and initial results of 12 patients. Materials and Method An audit of theatre records of a single surgeon was performed to identify patients who had undergone PVB for management of radiation-cystitis. Rigid cystoscopy was performed. Ureteric catheters were placed and active bleeding sites targeted to optimise vision. Ablation was commenced using the vaporize function. When lasering around delicate structures the coagulation function was used. Ureteric catheters remained in situ for 24h. An 18Fr Foley catheter was placed. When urine output was clear continuous bladder irrigation was ceased. Both uretetric catheters and Foley catheter were removed prior to the 24hour mark. Results 12 patients were identified. 8 had previously required blood transfusion secondary to bladder haemorrhage. 9 were successfully treated and 2 saw improvement in haematuria but required a repeat procedure at 3 weeks post operatively. 4 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. Conclusion Radiation cystitis can be life threatening and remains a challenge for the urologist with traditional intra-vescical treatments such as aluminium or formalin having variable results. We present an alternate technique using PVB to ablate the bladder mucosa, with good results. Consolidation with hyperbaric oxygen therapy may be considered. Our study is limited by small sample size and the presence of bilateral ureteric catheters leaving the bladder free from urine may impact immediate post operative outcomes. These initial results are promising however further prospective evaluation with a larger cohort and pre and post operative cystograms would enable better evaluation of this technique as a definitive management option for haemorrhagic cystitis.