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Holmium laser in Vesical lesions

Holmium laser can be used to, resect , ablate and coagulate various intravesical lesions as urothelial cancers, cystitis cystica and Hunners lesions ( Blaader pain Syndrome/Interstitial Cystitis). It has also been used to incise ureterocele.


Holmium Laser Treatment of Hunner’s Lesions in Bladder pain syndrome

Bladder pain syndrome is a clinical entity of perplexing origin resulting in misery and pain, both for the patients suffering from this unfortunate disorder as well as the treating urologist. Not only is the diagnosis difficult, the treatment has equally been frustrating. Classically the condition has two forms, one the ulcerative variety or the one with Hunner’s lesions and the other without the mucosal ulceration and scarring.
Twelve patients have been treated at PSRI hospital New Delhi between May 2007 and August 2009 with a diagnosis of Bladder pain syndrome. The current understanding of this disease has made possible to identify a higher percentage of patients with Hunner’s lesions (5/12).We have been using Holmium laser to ablate these lesions in the bladder under general anaesthesia giving rise to immense benefit and virtually a pain free remission. The procedure was tolerated well with no adverse effects. In addition to treatment with Holmium laser treatment, patients received antihistamines and antimuscarinic agents for improving the storage function of the bladder thereby reducing the frequency to acceptable levels. Follow up ranged from 26 months to 6 weeks. Patients without Hunner’s lesions were treated with the standard intravesical instillation as per the hospital protocol.
In conclusion, Holmium laser treatment of Hunner’s lesions appears to be a promising modality of treatment as per this small set of patients. Larger multicenteric studies need to be designed to further evaluate this modality.