Use of the neodymium : YAG laser for interstitial cystitis: A prospective study

Purpose: Interstitial cystitis is a disorder of the bladder characterized b y urgency and frequency of urination, and pelvic pain. The classic type of interstitial cystitis is characterized by Hunner's ulcers, which are focal regions of severe bladder inflammation. Patients with Hunner's ulcers tend to have more severe symptoms and are often refractory to medical management . We present a prospective series of patients who underwent ablative therap y of Hunner's ulcers using a neodymium (Nd):YAG laser. Materials and Methods: A total of 24 patients with interstitial cystitis un derwent ablative therapy for Hunner's ulcers. Medical therapy had failed in all cases. Using regional or general anesthesia the Nd:YAG laser under cys toscopic control was used to ablate the ulcers. The power setting was 15 W. with a firing duration of between 1 and 3 seconds. The procedure was perfo rmed on an outpatient basis. Symptoms were noted preoperatively and postope ratively. Results: All patients had symptom improvement within 2 to 3 days. The mean pain scores decreased from 9.1 to 1.2 (p <0.003), the mean urgency score de creased from 8.2 to 1.9 (p <0.003), the mean voiding interval increased fro m every 30 minutes to every 102 (p <0.0001) and nocturia decreased from a m ean of 7.9 voids per night to 2.9 (p <0.0001). There were no complications. Mean followup was 23 months. However, relapse in 11 patients required 1 to 4 additional treatments. The re-treatment response was similar to the init ial treatment. Conclusions: Nd:YAG laser ablation of Hunner's ulcers is an excellent, mini mally invasive method of treating interstitial cystitis, While it is not a cure, it offers patients an opportunity to have decreased symptoms far an e xtended period and it may be repeated as necessary.