Ureterocele fenestration with holmium laser in neonates

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COD: 13_2704_AOP Categorie: ,

Predrag Ilic, Mirjana Jankovic, Maja Milickovic, Slobodan Dzambasanovic, Vladimir Kojovic

Ann Ital Chir, Digital Edition 2018, 7
Epub Ahead of Print – June 23

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

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