Treatment of Cyclophosphamide Induced Hemorrhagic Cystitis with Neodymium: YAG Laser in Pediatric Patients

Abstract

Purpose Hemorrhagic cystitis is a significant and sometimes fatal complication of cyclophosphamide therapy. We report our recent experience using a neodymium (Nd):YAG laser to treat 3 pediatric patients with cyclophosphamide induced cystitis. Materials and Methods Between May 1994 and March 1995 we treated 3 pediatric patients 6 to 8 years old with an Nd:YAG laser for severe hemorrhagic cyclophosphamide induced cystitis. All patients presented with gross hematuria and conservative measures failed. The Nd:YAG laser (20 watts and 2-second pulse mode) was used to fulgurate bleeding endoscopically. All patients required 2 laser treatment sessions with a total energy range of 8,011 to 16,595 J. and strict parameters to avoid small bowel injury. Results All 3 patients had resolution of gross hematuria with Nd:YAG therapy. They were discharged home within 3 days after repeat laser treatment with grossly clear urine and stable hematocrit. At followup of 11 to 18 months the patients have grossly clear urine and they are free of symptoms. Conclusions Our experience suggests that the Nd:YAG laser can be effective and safe for treating refractory cyclophosphamide induced hemorrhagic cystitis in pediatric patients.