Invasive Treatment For Patients Research Articles

Initial Experience with a Magnetic Navigation System for Invasive Treatment in Patients with Non-ST-Segment Elevation Acute Coronary Syndromes

Magnetic navigation system (MNS) assisted percutaneous coronary intervention (MPCI) has been demonstrated an advantage over conventional PCI (CPCI) in complex lesions and tortuous vessels. However, the benefits of MNS in clinical unstable and vulnerable lesions were little studied. The aim of this study is to evaluate the feasibility and benefits of MPCI versus CPCI in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). Thirty-seven consecutive patients with NSTE-ACS undergoing MPCI were compared with 37 matched CPCI patients selected from the same concurrent database. Time to cross lesion, fluoroscopy time, and contrast usage to cross lesion were used as primary end-points. Of the 37 culprit lesions in MPCI, 36 were crossed successfully giving a success rate of 97.3%. The procedure and the fluoroscopy time to cross the lesion were similar between the magnetic and conventional PCI groups (82.0 ± 67.9 seconds vs. 85.8 ± 59.2 seconds, P = 0.692, and 62.6 ± 57.6 seconds vs. 65.4 ± 49.5 seconds, P = 0.738, respectively). In Type A/B1 lesions, there seemed no difference in contrast use (2.7 ± 0.7 mL vs. 3.3 ± 0.9 mL, P = 0.284). But as lesion complexity increased from type B2 to C, significantly less contrast was needed in type B2 (5.1 ± 2.6 mL vs. 7.9 ± 4.0 mL, P = 0.019) and type C (9.8 ± 5.7 mL vs. 14.7 ± 7.4 mL, P = 0.030). No major adverse cardiac events were observed in either the MPCI or CPCI group. MNS assisted technique appears to be feasible and effective in NSTE-ACS patients with more complex lesions; however, it probably offers little benefit in simple lesions like ACC/AHA type A/B1.

Letter by Benedetto et al Regarding Article, “Importance of Refractory Pain and Hypertension in Acute Type B Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection (IRAD)”

HomeCirculationVol. 123, No. 24Letter by Benedetto et al Regarding Article, “Importance of Refractory Pain and Hypertension in Acute Type B Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection (IRAD)” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Benedetto et al Regarding Article, “Importance of Refractory Pain and Hypertension in Acute Type B Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection (IRAD)” Umberto Benedetto, MD, PhD, Giovanni Melina, MD, PhD and Riccardo Sinatra, MD Umberto BenedettoUmberto Benedetto Department of Cardiac Surgery University of Rome La Sapienza Policlinico S. Andrea Rome, Italy (Benedetto, Melina, Sinatra) Search for more papers by this author , Giovanni MelinaGiovanni Melina Department of Cardiac Surgery University of Rome La Sapienza Policlinico S. Andrea Rome, Italy (Benedetto, Melina, Sinatra) Search for more papers by this author and Riccardo SinatraRiccardo Sinatra Department of Cardiac Surgery University of Rome La Sapienza Policlinico S. Andrea Rome, Italy (Benedetto, Melina, Sinatra) Search for more papers by this author Originally published21 Jun 2011https://doi.org/10.1161/CIRCULATIONAHA.110.991182Circulation. 2011;123:e636To the Editor:We read with great interest the article by Trimarchi et al1 that investigated the impact of refractory pain and hypertension in patients with acute type B aortic dissection. The authors concluded that this subgroup had a higher in-hospital mortality, and this was particularity evident when these patients were managed medically.Trimarchi et al1 did not provide the number of patients with refractory hypertension and pain separately, but conducted the analysis by pooling patients with such conditions in a unique intermediate risk group. Even if these 2 conditions may coexist, it has been demonstrated that refractory hypertension and refractory pain are not directly associated.2,3 Therefore, this method seems questionable to us. The unreliability of such a combination was supported by the wide range of 95% confidence intervals in odds ratios relative to the intermediate risk group in the multivariate analysis (1.01 to 10.45). It might be more useful to report the association between each condition and mortality separately.The poorer outcome observed in the intermediate risk group may be more realistically explained by anatomic conditions than by refractory hypertension or pain. In fact, patients with intermediate risk more often had Marfan syndrome (P=0.03) and descending aorta >6 cm (P=0.02), arch vessel, and abdominal vessel involvement; and less often, they had a complete false lumen thrombosis (P=0.005). All these anatomic aspects may have played a major role in determining the outcomes in this group.4 On the other hand, patients experiencing refractory hypertension or pain surprisingly received invasive treatment later than completely asymptomatic patients, thus losing the benefit of an early intervention in selected patients.Finally, the authors did not provide any definition for refractory hypertension or pain. They reported an overall incidence of 18.9% of this condition among 365 patients with uncomplicated acute type B aortic dissection. These data do not agree with those previously reported from the Massachusetts General Hospital Thoracic Aortic Center database,2,3 in which refractory hypertension and/or refractory pain was a very common phenomenon that was present in 81% of patients with uncomplicated anatomic conditions. In such studies, refractory hypertension was defined as a need for ≥4 adequately dosed antihypertensive agents used simultaneously to achieve a systemic arterial pressure ≤140/80 mm Hg,3 and recurrent pain was defined as the return of discomfort after relief of the presenting pain.2 The authors should mention whether they adopted the same definition and comment on any eventual discrepancy.In conclusion, results reported by Trimarchi et al1 do not definitely support the need for routinely performing invasive treatment in patients with recurrent pain or hypertension in the absence of clear evidence of anatomic complications.Umberto Benedetto, MD, PhDGiovanni Melina, MD, PhDRiccardo Sinatra, MD Department of Cardiac Surgery University of Rome La Sapienza Policlinico S. Andrea Rome, ItalyDisclosuresNone.

Natriuretic peptide type-B can be a marker of reperfusion in patients with pulmonary thromboembolism subjected to invasive treatment

This study was intended to investigate changes in cardiac biomarkers and pulmonary hemodynamic effects of invasive treatment in patients with intermediate-risk (hemodynamic stability with evidence of right ventricle dysfunction and/or myocardial injury) pulmonary embolism. Also, to also evaluate if natriuretic peptide type-B (NT-proBNP) plasma levels are associated with right ventricle function and pulmonary arterial pressures. Interventional study: Fourteen normotensive adult patients with acute and radiologically massive pulmonary embolism plus positive biomarkers and evidences of right ventricle dysfunction underwent invasive pulmonary angiography for invasive treatment consisting on mechanical thrombus fragmentation and catheter-directed intrathrombus thrombolysis. Angiography was repeated after 12-24 h to reevaluate perfusion status. Plasma biomarkers were monitored before and 8-h after intervention. Biomarkers were initially elevated in all patients. Eleven patients (78.6%) exhibited significant angiographic reperfusion. NT-proBNP and mean pulmonary arterial pressure decreased significantly in all of them [3693 (1803, 8862) to 1951 (1309, 7918) pg/ml; P = 0.008) and 40.0 (24.0, 46.0) to 22.0 (14.0, 27.0) mmHg; P = 0.003, respectively]. No significant variation was observed in troponin-T levels. In patients with high-risk pulmonary embolism, NT-proBNP plasma levels experience rapid and significant reduction after successful invasive treatment. In pulmonary embolism, serial measurements of NT-proBNP could be useful as a tracking tool to assess the success or failure of the thrombolytic treatment.

Robotic-Assisted Cryosurgical Treatment of Atrioventricular Node Reentrant Tachycardia

Atrioventricular nodal reentrant tachycardias typically arise from the existence of variable refractoriness in fast and slow conduction pathways within the triangle of Koch, which provide input to the atrioventricular node. Standard therapy includes medical management and catheter-based ablation procedures. Robotic-assisted, minimally invasive cryosurgical modification of the atrioventricular node can provide definitive therapy for patients who fail traditional therapy. A 65-year-old man presented with a several-year history of recurrent atrioventricular nodal reentrant tachycardia. Despite medical management and attempted percutaneous ablation, the patient remained symptomatic with weekly episodes. Access was via a 4-cm right anterolateral thoracotomy and peripheral perfusion. The da Vinci S robotic system was used to manipulate the cryoprobe (CryoMaze Probe; ATS Medical, Plymouth, MN USA). A series of spot freezes (tip 60°C) were made along the boundaries of the triangle of Koch until transient complete heart block was achieved and nodal rhythm was recovered. At follow-up 3 weeks postoperatively, the patient was asymptomatic in first-degree heart block. Robotic-assisted cryosurgical atrioventricular node ablation is an effective, minimally invasive treatment for patients with atrioventricular nodal reentrant tachycardia.

Invasive treatment of patients with cardiomyopathy: CRT-ICD better than ICD alone

Invasive treatment of patients with cardiomyopathy: CRT-ICD better than ICD alone

Effect of Invasive Treatment on Prognosis in Non-ST-Segment Elevation Acute Coronary Syndrome With or Without Systolic Dysfunction

Few data are available on the use of invasive treatment in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) and systolic dysfunction. The aim of this study was to determine the effect of invasive treatment on the prognosis of patients with NSTEACS, with or without systolic dysfunction. The study included 972 consecutive patients admitted for NSTEACS (i.e. ST-segment depression or an elevated troponin-I level). Systolic dysfunction was defined as an ejection fraction <50% on transthoracic echocardiography. The primary long-term endpoint was death or myocardial infarction. The effect of invasive treatment on prognosis was evaluated by Cox regression analysis. Overall, 23.4% of patients had systolic dysfunction, and 303 (31.2%) reached the primary endpoint, which was more frequent in those with systolic dysfunction (49.8% vs. 25.5%; P< .001). Usage of coronary angiography and revascularization procedures were similar in patients with systolic dysfunction and those with an ejection fraction >/=50% (59% vs. 63.4%; P=.239; and 38.3% vs. 38.8%; P=.9; respectively). Detailed adjusted multivariate analysis, including the use of a propensity score, demonstrated that coronary angiography had a differential effect on prognosis depending on the presence or absence of systolic dysfunction (interaction, P=.01). Catheterization was clearly beneficial in patients with systolic dysfunction (hazard ratio [HR]=0.47; 95% confidence interval [CI], 0.3-0.75; P=.001) but not in those with an ejection fraction >/=50% (HR=0.9; 95% CI, 0.63-1.29; P=.567). The presence of systolic dysfunction identifies those patients with NSTEACS who will benefit most from invasive treatment.

Long-term effects of invasive treatment in patients with a post-thrombolytic Q-wave myocardial infarction

Objectives. The aim of the present study was to assess the effect of a deferred invasive treatment strategy on long-term outcome in patients with a post-thrombolytic Q-wave myocardial infarction and inducible myocardial ischemia. Design. Patients (N=751) with post-thrombolytic Q-wave myocardial infarction and inducible ischemia (angina pectoris or silent myocardial ischemia) were randomized to a deferred invasive treatment (balloon angioplasty or coronary bypass surgery) or medical treatment. Vital status and non-fatal cardiac events defined as hospitalization caused by acute cardiac events were recorded for a median of 11.4 years. Results. Survival was significantly improved in patients receiving invasive treatment compared to patients treated medically (hazard ratio 0.85 (95% confidence limits 0.73–0.99), p=0.034). Subgroup analysis showed a reduction of non-fatal cardiac events and improved survival among the patients with post-infarction angina pectoris and not among the patients with silent myocardial ischemia. Conclusions. A deferred invasive treatment strategy improves survival compared to medical treatment in patients with inducible myocardial ischemia after a post-thrombolytic Q-wave myocardial infarction.

Efficacy of botulinum toxin type A treatment of functional impairment of degenerative hip joint: Preliminary results

The aim of this study was to investigate the effect of botulinum toxin type A injection into the adductor muscles in reducing pain and improving joint mobility and quality of life in patients affected by hip osteoarthritis. A total of 39 outpatients, mean age 68 years (age range 41-82 years), were evaluated using the Harris Hip Score to test hip function, a visual analogue scale to measure pain intensity and the Short Form 36 (SF-36) questionnaire to assess patient well-being and quality of life at baseline, 2, 4 and 12 weeks after treatment with botulinum toxin type A. A total of 400 U of botulinum toxin type A (Dysport) was injected into the adductor longus muscle and the adductor magnus muscle. The Harris Hip Score increased significantly after 2, 4 and 12 weeks (df 3, chi2 = 45.1; p < 0.0001). A significant decrease in pain intensity was detected at all the follow-up visits, after 2, 4 and 12 weeks (df 3; chi2 = 27.8; p < 0.001). The SF-36 score was significantly higher 4 and 12 weeks after treatment. At each evaluation visit a significant correlation was detected between decreased pain and improved hip mobility. Botulinum toxin type A induced a reduction in pain, indicating that this might be an innovative, less invasive treatment in patients affected by severe hip osteoarthritis, with remarkable effects on the clinical management of this disease.

Invasive treatment of patients with cardiomyopathy: CRT-ICD better than ICD alone

In the December issue of our journal, special attention is paid to the underlying mechanisms and various manifestations of cardiomyopathy. In particular, new pathways in the diagnosis and treatment of patients with cardiomyopathy have been addressed. Of the modern management strategies, cardiac resynchronisation therapy (CRT) has become a mainstay in the treatment of patients both with ischaemic and nonischaemic cardiomyopathies. CRT induces progressive reverse left ventricular (LV) remodelling and delays disease progression in patients with NYHA class III or IV heart failure. The question whether CRT is also beneficial in patients with NYHA class I and II was recently addressed in the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation Trial – Cardiac Resynchronization Therapy).

Predictive factors of lymph node metastasis in early mucinous adenocarcinoma

OBJECTIVE To identify clinicopathologic factors which predict lymph node metastases (LNM) in early mucinous adenocarcinoma patients, and to further explore the possibility of using minimally invasive treatment for patients with the disease. METHODS Data was collected from 38 patients with early mucinous adenocarcinoma who were surgically treated, and the association between clinicopathologic factors and the presence of LNM was retrospectively analyzed using univariate and multivariate logistic regression analysis. RESULTS Tumor size greater than 2.0 cm, the development of submucosal invasion, and the presence of lymphatic vessel involvement (LVI) were con fi rmed through univariate analysis as having a significant association with LNM and were considered to be significant and independent risk factors for LNM through multivariate analysis. CONCLUSION Tumor size > 2.0 cm, the development of submucosal invasion, and the presence of LVI are independent predictive factors for LNM in early mucinous adenocarcinoma. Minimally invasive treatment may be an effective treatment for intramucosal early mucinous adenocarcinoma when the tumor size is 2.0 cm or less, and if LVI has not occurred, as confi rmed by postoperative histologic examination.

Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer

Endoscopic resection (ER) has been accepted as minimally invasive treatment in patients with early gastric cancer (EGC) who have a negligible risk of lymph node metastasis. It has already been determined which lesions in differentiated-type EGC present a negligible risk of lymph node metastasis, and ER is being performed for these lesions. In contrast, no consensus has been reached on which lesions in undifferentiated-type (UD-type) EGC present a negligible risk for lymph node metastasis, nor have indications for ER for UD-type EGC been established. We investigated 3843 patients who had undergone gastrectomy with lymph node dissection for solitary UD-type EGC at the Cancer Institute Hospital, Tokyo, and the National Cancer Center Hospital, Tokyo. Seven clinicopathological factors were assessed for their possible association with lymph node metastasis. Of the 3843 patients, 2163 (56.3%) had intramucosal cancers and 1680 (43.7%) had submucosal invasive cancers. Only 105 (4.9%) intramucosal cancers compared with 399 (23.8%) submucosal invasive cancers were associated with lymph node metastases. By multivariate analysis, tumor size 21 mm or more, lymphatic-vascular capillary involvement, and submucosal penetration were independent risk factors for lymph node metastasis (P < 0.001, respectively). None of the 310 intramucosal cancers 20 mm or less in size without lymphatic- vascular capillary involvement and ulcerative findings was associated with lymph node metastases (95% confidence interval, 0-0.96%). UD-type intramucosal EGC 20 mm or less in size without lymphatic-vascular capillary involvement and ulcerative findings presents a negligible risk of lymph node metastasis. We propose that in this circumstance ER could be considered.

S35 Optimal primary minimally invasive treatment for patients with stress urinary incontinence and symptomatic pelvic organ prolapse

S35 Optimal primary minimally invasive treatment for patients with stress urinary incontinence and symptomatic pelvic organ prolapse

The Impact of a Well Structured Vascular Registry in Assessing the Long-Term Survival After Repair of Abdominal Aortic Aneurysms

Over the last 2 decades, the treatment of infrarenal abdominal aortic aneurysms (AAAs) has been characterized by significant improvement in patient outcomes. Many important contributions have been made in assessment of the natural history, improvement in patient selection, effective preoperative risk factor modifications, and development and introduction of new therapeutic options in the management of patients with this potentially fatal condition. Endovascular aneurysm repair (EVAR) was initially recommended by Parodi and collaborators1 for patients not suitable for open AAA repair. The Food and Drug Administration approval of 2 endoluminal devices for the treatment of AAA in 1999 began a new era of less invasive treatment for patients with this condition. This new therapeutic approach has been accepted widely in the United States, with nearly 60% of Medicare-eligible patients with elective AAA repair being treated by this less invasive technique.2 This new technique has been adopted widely by variable-volume hospitals throughout the world. Anderson and colleagues3 reported on the impact of …

Update on neuromodulation for frequency, urgency, retention, and neurogenic voiding dysfunction

Neuromodulation offers a reversible and minimally invasive treatment for patients with urge incontinence, urinary urgency-frequency syndrome, and nonobstructive urinary retention that is refractory to conservative therapy. Despite many advances in the techniques of neuromodulation, the mechanism of neuromodulation of bladder function remains undefined. It seems to involve activation of peripheral afferent nerves and may influence bladder function in part through a supraspinal mechanism. Neuromodulation of bladder function is clinically available via US Food and Drug Administration-approved techniques of sacral nerve root stimulation and posterior tibial nerve stimulation. Sacral neuromodulation has emerged as the preferred treatment for symptoms that are refractory to conservative management. Few predictors of response to sacral neuromodulation have been identified. Alternative, more peripheral forms of neuromodulation for bladder dysfunction such as pudendal and dorsal genital nerve stimulation are being studied.

Intraoperative Cholangiography in Modern Surgical Practice

Background/Aims: The aim of this study was to assess the practice of performing intraoperative cholangiography (IOC) during laparoscopic cholecystectomy in a busy teaching hospital. Methods: Data were obtained from a surgical database for patients who underwent laparoscopic cholecystectomy between January 2000 and December 2003. The findings of IOC and follow-up were analysed. Results: 1,651 patients were included in the study. Of the 745 patients (45.1%) who underwent IOC, this was normal in 586 patients and abnormal in 68 patients. Of these 68 patients, 4 underwent immediate conversion to open common bile duct exploration. 33 patients underwent endoscopic retrograde cholangiopancreatography and 31 patients were observed. During a median follow-up period of 920 days (range 371–1,821), 5 of the 745 patients had retained stones. Two patients re-presented after a failed IOC while 5 of the 906 patients from the non-cholangiogram group returned with stones. Of the 1,651 patients, definite stones were identified in 1.5% patients. Conclusion: When the surgeon deemed that IOC was not required, very few subsequent problems were encountered. An observational policy with monitoring of the liver function tests may be appropriate to avoid unnecessary invasive interventions in patients with an abnormal IOC.

Percutaneous tibial nerve stimulation: a new treatment for faecal incontinence

Percutaneous tibial nerve stimulation is a new non−invasive treatment for patients with faecal incontinence that can be given in an outpatient setting by specialist nurses. It is safe and cost effective (Shafik et al, 2003) and early data suggest it is as effective as established alternative treatments. This article reviews the development of the technique and early clinical studies into its effectiveness, how it is carried out and the experience at Barts and the London NHS Trust. It then goes on to discuss the implications for specialist practice and the need for continuing research to extend one′s knowledge of this treatment option for faecal incontinence.

Extracorporeal Shock Wave Therapy as First Line Treatment in Patients with Peyronie's Disease

Introduction Extracorporeal Shock Wave Therapy (ESWT) is a minimal invasive treatment for patients with Peyronie's Disease (PD). Currently, however, controversial data exist on the efficacy of ESWT as first-line treatment. Methods We performed a prospective, randomized, double blind, placebo-controlled trial to evaluate the efficacy of ESWT in a group of 100 patients with disease duration &lt;12 months, naive to previous treatments, with a single plaque, erectile dysfunction and/or painful erections and/or penile recurvatum. Patients were randomized to undergo ESWT or Placebo. The Storz Duolith device was employed for treatments. A non-functioning probe was employed as placebo. Treatments were administered in four sessions at weekly intervals. The following evaluations were performed at baseline and at 12- and 24-week intervals from treatment: IIEF-5 (International Index of Erectile Function) questionnaire, VAS (Visual Analogue Scale), plaque size measurement, penile curvature measurement. Results Only patients treated with ESWT reported a significant improvement of mean VAS score and of mean IIEF-5 score at a 12-week follow-up. Mean plaque size and mean curvature degree did not improved significantly in patients treated with ESWT but showed a significant worsening at the 24-week follow up compared to baseline values in the placebo group. Conclusions ESWT can improve significantly painful erections and erectile functions in patients with PD naive to other treatments. Moreover, ESWT can stabilize plaque size and penile curvature thus preventing disease progression.

Reliability of endoscopic esophageal mucosectomy using TxHood, a multipurpose treatment hood

Endoscopic mucosectomy, comprising both endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), is a minimally invasive treatment for patients with early esophageal carcinoma. The use of ESD is appropriate for mucosal lesions of any size. However, ESD techniques are relatively difficult and can lead to serious complications such as perforation and massive bleeding, which have been reported more frequently after ESD than after EMR. This study describes a novel technique for ESD using a newly designed multipurpose treatment hood (TxHood) as well as basic experiments to ensure its safety. The TxHood includes various therapeutic tools such as an electric needleknife, a snare wire, and an injection needle, and the lines can be selected freely before insertion of an enodoscope covered by a TxHood. The main techniques for ESD are endoscopic submucosal saline injections on demand through a working channel of the endoscope or TxHood and a cut or swing cut with a needleknife attached to the TxHood. Moreover, the target area can be grasped with a grasping forceps through a working channel of the endoscope to obtain effective countertraction. In these experiments, an electric needleknife set parallel to the shaft of the endoscope offered safety and ease of handling for the dissecting procedures. Altogether, 16 resections of mucosa with an average size of 3.5 x 2.5 cm (range, 2 x 2 to 7 x 4 cm) were performed. The average time required for each targeted endoscopic resection area was about 15 min. No perforations or instances of uncontrollable bleeding occurred. In conclusion, this basic study demonstrates that the new ESD technique with the TxHood provides a useful treatment for early esophageal carcinoma and may be applicable for all mucosal or submucosal tumors in the gastrointestinal tract.

Contemporary management of peripheral arterial disease: III. Endovascular and surgical management.

Traditional indications for invasive treatment in patients with peripheral arterial disease (PAD) have been salvage of a threatened limb or improvement of functional capacity in cases of disabling intermittent claudication, but advances in interventional therapy may be lowering the threshold for these therapies. Percutaneous transluminal angioplasty (PTA), with or without stent placement, is the most common endovascular intervention in patients with occlusive lower extremity PAD. In general, PTA is best suited to cases of short-segment stenosis or large-bore vessels, whereas surgery is best applied to multilevel occlusions involving smaller and more distant vessels. This article reviews endovascular therapy, catheter-based thrombolysis, and surgical revascularization procedures in patients with PAD, with special attention to recommendations from new American College of Cardiology/American Heart Association guidelines.

A new minimally invasive technique for treating radiation cystitis: the argon‐beam coagulator

To assess the effectiveness of the argon-beam coagulator used endoscopically for treating radiation cystitis, as radiotherapy is commonly used for treating pelvic tumours of urological origin, but intractable bleeding related to radiation cystitis remains a serious complication and requires a difficult long-term follow-up, for which cystoscopic methods of management have traditionally had limited success. We assessed seven patients with radiation cystitis; they were treated with argon-beam coagulation after a cystoscopic evaluation. With a mean follow-up of 15 months, one treatment was used in six patients, with a second treatment required in one. The argon-beam coagulator appears to be a safe, well tolerated and minimally invasive treatment in patients with radiation cystitis.