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.