Treatment of Interstitial Cystitis with the Neodymium: YAG Laser

Abstract

The use of the neodymium:yttrium aluminum garnet (Nd:YAG) laser in the treatment of superficial carcinoma of the bladder was first described by Staehler and Hofstetter in the 1970s. Since that time, other authors have confirmed the usefulness of this new modality of therapy in the treatment of both superficial and invasive carcinoma of the bladder (Smith 1986; Beisland et al. 1985). The methodology used is to photoirradiate the bladder carcinoma with the Nd: YAG laser, delivered via a fiberoptic bundle passed through a cystoscope, until the bladder wall and tumor turn a chalk-white in appearance. This visual end point has been shown to correspond to heating the protein in the cells of the bladder to approximately 60–70°C. At this temperature the elastic fibers of the bladder are not damaged (Hofstetter and Frank 1980). Over the next 4–6 weeks the cells of the tumor and bladder wall necrose, slough off, and are replaced with healthy collagen fibers. If too high a laser energy is used, the tissue vaporizes or turns black with superficial carbonization, which is a process to be discouraged because of the increased absorption of laser energy superficially by the carbonization itself.