Neodymium:YAG laser treatment of bladder hemangiomas

Klippel-Trenaunay Syndrome Associated With Urinary Tract Hemangiomas: A Case Report

The association between Klippel-Trenauney syndrome (KTS) and bladder hemangiomas is rare. The most common clinical manifestation is hematuria. The diagnosis is made from the characteristic cystoscopic appearance of the tumor. We report the case of a patient presenting recurrent macroscopic hematuria in the context of KTS. A cystoscopic evaluation revealed bladder hemangiomas. A conservative approach consisting of bladder irrigation and close follow-up was chosen as therapy. Conservative treatment of bladder irrigation and close follow-up is the recommended initial treatment of moderate and infrequent episodes of hematuria in this context. The more invasive therapeutic options have to be considered especially for frequent or life-threatening episodes of hematuria. This case suggests that conservative treatment may be effective in treating moderate and infrequent episodes of hematuria due to bladder hemangioma in the context of KTS. Further studies are required to adequately establish the effectiveness, limitations, and complications of each approach.

A case of large bladder hemangioma successfully treated with endoscopic yttrium aluminium garnet laser irradiation

Bladder hemangioma is a rare benign tumor. While partial cystectomy remains an effective treatment option for large bladder hemangioma, the combined method of neodymium:yttrium aluminium garnet and holmium:yttrium aluminium garnet laser irradiation is an effective and less invasive treatment option. We report a case of large bladder hemangioma in an otherwise healthy 4-year-old boy, successfully treated with serial endoscopic yttrium aluminium garnet laser irradiation. There was no recurrence, and normal bladder function was preserved. Serial yttrium aluminium garnet laser irradiation is thus a useful, less invasive method for cases of large tumors.

Urogenital involvement in the Klippel-Trenaunay-Weber syndrome. Treatment options and results

OBJECTIVE

Klippel-Trenaunay-Weber syndrome (KTWS) is a congenital condition characterized by vascular malformations of the capillary, venous and lymphatic systems associated to soft tissue and bone hypertrophy in the affected areas. This syndrome may involve bladder, kidney, urethra, ureter and genitals. We report the treatment of 7 KTWS patients with urogenital involvement.

MATERIALS AND METHODS

From 1995 to 2005, 7 patients with KTWS were evaluated and the charts of these patients were reviewed.

RESULTS

Patients' median age was 19-years (range 4 to 46-years) and only 1 was female. The clinical presentation included genital deformities in 3 cases, hematuria in 2 and urethrorragia in 2, one of which associated with cryptorchidism and phimosis. Three patients had an association of pelvic and genital malformations, including 2 patients with hematuria due to vesical lesions and 1 patient with left ureterohydronephrosis due to a pelvic mass. Two patients had urethral lesions. Treatment included endoscopic laser coagulation for 1 patient with recurrent hematuria and 1 patient with urethrorrhagia, pelvic radiotherapy for 1 patient with hematuria and circumcision in 2 patients with genital deformities. One patient required placement of a double-J catheter to relieve obstruction. Hematuria and urethrorragia were safely and effectively controlled with laser applications. Circumcision was also effective. The patient treated with radiotherapy developed a contracted bladder and required a continent urinary diversion.

CONCLUSIONS

Urogenital involvement in patients with KTWS is not rare and must be suspected in the presence of hematuria or significant cutaneous deformity of the external genitalia. Surgical treatment may be warranted in selected cases.

Hémangiome vaginal révélé par un saignement chez une petite fille : à propos de 1 cas

We report on the case of a 9-year-old girl who presented vaginal bleeding which led to the diagnosis of vaginal hemangioma. Such localisation is rare, and requires a clinical follow-up by vaginoscopy. A spontaneous regression can be expected but, at this time, the progress of puberty and future fertility are unknown.

[Vesical cavernous hemangioma]

The vesical cavernous hemangioma is a rare tumor with a begin biological behaviour. This sort of tumor has particular diagnostic and therapeutical features, and a variety of treatments has been used on it. The case of cavernous hemangioma in the bladder that we present was only diagnosed after RTU due to preoperative diagnosis of urotelial vesical tumor. We review clinical, diagnostic and therapeutical features of this kind of tumor.

Endoscopic neodymium:yttrium aluminium garnet (Nd:YAG) laser irradiation of a bladder hemangioma associated with Klippel-Weber syndrome

A case of endoscopic neodymium:yttrium aluminium garnet (Nd:YAG) laser coagulation of a bladder hemangioma associated with Klippel-Weber syndrome is presented. The patient presented with extensive nevus and swelling of the left lower limb since birth. She was diagnosed with Klippel-Weber syndrome by angiography at the age of 1 year. Gross hematuria had been observed since she was 1 year old and, in addition, endoscopic examination revealed diffuse bladder hemangiomas. At 8 years of age, gross hematuria became worse and gait disturbance also appeared. She was referred to the Department of Urology at Tohoku University School of Medicine for endoscopic treatment in June 1998. Under general anesthesia, the bladder was inflated with CO2 gas and the hemangiomas were coagulated by Nd:YAG laser photonic irradiation endoscopically. Gross hematuria was markedly improved immediately following this treatment. Klippel-Weber syndrome is a rather uncommon disease which shows various types of vascular anomaly and hypertrophy of the lower extremities. Three to 6% of the patients have associated bladder hemangiomas. Although Nd:YAG laser irradiation provides results superior to alternative therapy and is the preferred treatment for most patients with bladder hemangioma, in this case, hemangiomas are multiple and present the possibility of re-bleeding, therefore long-term and close follow up is important.

[Tuberous angioma of the glans penis: treatment with laser and local anesthesia]

A case of angioma tuberous of the glans penis treated with Neodymiun:Yag laser under local anesthesia in a eleven-years-old outpatient is reported. These lesions are extremely rare. Local excision of this tumor was accepted treatment, but we think that laser treatment (Neodymiun:Yag) is far superior to surgical excision and we think this treatment of choice. The particularity of the case we report, is aside the rarity, the possibility of treatment in an outpatient child, with local anesthesia and excellent tolerance.

Hematuria in a newborn infant caused by bladder hemangioma

A newborn boy had gross hematuria caused by hemangiomas of the bladder. The sonographic examination and the voiding cystourethrogram showed an irregular and thick bladder wall with a lesion extending into the vesical lumen. Cystoscopic examination and biopsy of the lesions were diagnostic of hemangioma. Immediately after lesion fulguration, the hematuria disappeared, and 3 weeks later the follow-up ultrasound examination showed resolution of the lesion. At 1 year, the patient's urinalysis and ultrasound scan were normal. To our knowledge, this is the first reported case of hematuria in a newborn caused by a bleeding hemangioma of the bladder.

Video-assisted percutaneous cystoscopy of the bladder and prostatic urethra in the dog: new approach for visual laser ablation of the prostate

A new minimally invasive approach for video laparoscopy was developed to access the bladder and prostatic urethra of the dog in order to perform laser ablation of the prostate without using either an open laparotomy or urethrostomy. During general anesthesia, a 10-mm laparoscope was introduced into the peritoneal cavity. Under direct vision, the bladder was distended, and trocars were placed percutaneously by two different methods. A 22F cystoscope was introduced through the transcystic trocar into the prostatic urethra for visual laser ablation of the prostate (VLAP). In all eight dogs, the video-assisted technique for percutaneous access to the prostatic urethra was successful. No complications were associated with placement of the Veress needle, creation of the pneumoperitoneum, or accessing of the bladder lumen and proximal urethra. The visibility in the peritoneal cavity was excellent, and hemorrhage was minimal in all cases. In two dogs, a laparotomy was performed after displacement of the cystoscope from the urinary bladder. Irrigation fluid for the cystoscope drained primarily around the trocar cuff surrounding the instrument. In one case, the irrigation fluid drained around the trocar in the bladder and filled the peritoneal cavity.

Endoscopic neodymium:YAG laser treatment of radiation-induced hemorrhagic cystitis

Hemorrhagic cystitis is a debilitating complication of radiation therapy for pelvic malignancy. Forty-two such patients with intractable hematuria underwent endoscopic Nd:YAG laser coagulation under local anesthesia between January 1990 and July 1992. The laser power was kept at < or = 30 W and the pulse duration < or = 3 s. Control of bleeding was achieved in 39 patients after one sitting and in 2 patients after two sittings of laser treatment. There were no complications of the procedure and recurrence of bleeding was not seen in any of the patients achieving CR at a mean follow-up period of 14 months. With modifications in the safety guidelines, we recommend laser treatment as the initial procedure of choice in patients with hemorrhagic radiation cystitis.