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

Abstract

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.

A rare cause of hemorrhagic shock in children: bladder hemangioma

“…In hemangiomas covering a wide area or those multiple in number, partial cystectomy or bladder augmentation with simple cystectomy, and in small tumors YAG (yttrium aluminium garnet), laser coagulation are the treatment options that may be preferred [10].…”

Prolapsed Urinary Bladder Haemangioma: A Rare Presentation

“…Various treatment options are available, small lesions can be managed endoscopically with laser ablation (YAG) or coagulation [4,5]. Large lesions require open surgical resection with partial cystectomy [6].…”

Urogenital involvement in the Klippel-Trenaunay-Weber syndrome: treatment options and results

“…Since then, a few cases have been described, with good results (12,13,15,16). In 1990, Smith reported 13 cases of patients with bladder hemangiomas who underwent treatment with Nd:YAG laser, 6 of whom with KTWS (2).…”

“…Partial cystectomy used to be the standard treatment but carries significant morbidity (10,11). Selective embolization of the internal iliac arteries may also be employed, but recurrence due to rapid development of collateral circulation and bladder or prostate infarction has been described (12). Radiotherapy is another therapeutic modality, but only temporary beneficial results are expected, while the morbidity can be excessive (13).…”

“…In Case 5, the endoscopic approach was used with some technical aspects differing from those described in the literature. We used saline solution to fill the bladder as opposed to CO 2 utilized by Kato (12). Since the lesion was very large, our strategy was to initially coagulate the margins of the lesions, in order to decrease blood supply to the bleeding sites.…”