Use of the Argon Plasma Coagulator in Refractory Hemorrhagic Cystitis

Abstract

Introduction:

The use of the argon plasma coagulator (APC) has been well documented in the endoscopic treatment of radiation-induced proctitis. Here we present our experience with the application of this technology in endourology.

Materials and Methods (including a description of the video):

APC treatment is performed under CO₂ insufflation. We performed air cystoscopy using a laparoscopic CO₂ insufflator with settings of 15 mm Hg and 1 L/min. The Erebe^® APC, at settings of 1 L/min gas flow and power of 60 watts, with a 7F 220 cm probe was used. The bladder was inspected and all areas of concern were coagulated. The video presented here is of a patient with hemorrhagic cystitis (HC) as a result of chronic cyclophosphamide use. This remained refractory to maximal medical therapy and prolonged continuous bladder irrigation (CBI) (21 days) utilizing a supra pubic tube.

Results:

The patient remained on CBI for 1 day postoperatively. His urine cleared and he was discharged with supra pubic in place 2 days after APC. He required no more blood products and his urine has remained clear at 3-month follow-up. These results are similar to the series reported by Wines and Lynch. ¹ They reported on seven patients with HC subsequent to radiation treatment. They had one failure at a mean follow-up of 15 months.

Conclusions:

The APC is a treatment option in patients with refractory HC. Its use should be considered in patients who fail conservative measures.

All authors have declared no conflicts of interest exist.

Runtime of video: 6 mins 40 secs