Fulguration of Hunner lesions is specifically recommended for Hunner type IC with evidence level 3 or recommendation Grade B-C in clinical guidelines [1–4]. The introduction of the neodymium: yttrium aluminum-garnet laser (Nd:YAG) in 1985 by Shanberg and Malloy [5] offered the theoretical possibility of primary Hunner type IC or recurrent ulcer treatment. Authors have found it necessary to lower the wattage of energy used to prevent damage to structures adjacent to the bladder. Most patients (17 of 19) with Hunner lesion showed good results, but 12 reported recurrence of symptoms between 6 and 8 months’ post-treatment. The outcome was worse in non-Hunner type of disease and did not exceed 65%. In two patients, small—bowel perforations occurred.

A study by Chennamsetty et al. [6] reported that 89.6% of 76 Hunner type IC patients noted some degree of symptom improvement after fulguration and 98% of patients answered that they would undergo fulguration when symptoms recurred. Hillelsohn et al. [7] reported that 45.8% of 59 Hunner type IC patients required repeated fulguration with a mean time between fulgurations of 20.3 months. A recent study by Niimi et al. confirmed these observations with a larger sample size [8]. In our experience holmium: YAG laser seems preferable (with a power of 20 Watt, output energy of 3 J, wavelength of 2100 nm) for endovesical coagulation of Hunner’s lesions. It is less dangerous and has the same efficacy [9]. Results showed a significant immediate reduction of pain and improvement of the quality of life of the patients. By using the usual parameters for tissue destruction (blanching without charring) the depth of thermal injury in the bladder was kept superficial. Note that when performing partial nephrectomies, a twofold reduction in the zone of coagulative necrosis was demonstrated compared to the use of the continuous wave Nd:YAG laser [10].