Ureterocele fenestration with holmium laser in neonates

Abstract

AIM: To evaluate the effectiveness of holmium-laser fenestration of intravesical ureteroceles in neonatal period.

MATERIAL AND METHOD: We retrospectively analyzed the results of the holmium-laser puncture in ten neonates with intravesical ureterocele, between September 2013 and September 2016. Laser probe was placed through the cystoscope to the lowest and medial portion of the ureterocele, near the bladder floor. Few punctures (4 to 8) were made, until urete- rocele has been collapsed.

RESULTS: Mean duration of general anesthesia was 16 minutes (range, 10-24) and duration of hospitalization was 1-3 days (mean, 1.3 days). There weren’t complications regarding endoscopic treatment. There was the need for retreatment in one (10%) patient. Obstruction was found in one (10%) patient on ultrasound after one month. After three months there was no obstruction on ultrasound in any patient. In patients in whom VCUG was performed, vesicoureteral reflux was not found three months after the surgery.

DISCUSSION: The relief of the obstruction, prevention of the vesicoureteral reflux and the urinary tract infection are the reasons for the immediate treatment in the neonatal period. In that way, the preservation of renal function is enabled. The reason for laser fenestration was better endoscopic control of the extensibility of the ablation. The moment of urete- rocele collapsing can be visualized directly.

CONCLUSIONS: Holmium-laser fenestration is a minimally invasive, highly effective and safe kind of treatment for urete- rocele in neonatal period with minimal complication rate. Further clinical studies with a greater number of patients will offer more reliable information regarding this procedure.