Prevention of vesicoureteral reflux in neonatal patients with intravesical ureterocele using holmium-laser

Abstract

AIM: To evaluate the effectiveness of laser fenestration of intravesical ureterocele in prevention of vesicoureteral reflux.

MATERIAL AND METHODS: The result of intravesical ureterocele holmium laser fenestration (LF) was retrospectively analyzed in 29 neonatal patients (mean age 8.1 days, range 3-28) in comparison with 38 neonates (mean age 9.6 days, range 5-28) treated with electrosurgical incision (ES). Patients’ records were reviewed for preoperative findings, endoscopic procedure description and postoperative outcomes.

RESULTS: Vesicoureteral reflux (VUR) was found in two patients (5.6%) in LF and in 25 patients (65.8%) in ES group after six months (P=0.000). The patients with VUR in LF group had reflux grade III. In ES group six patients (15.8%) had reflux grade III, ten (26.3%) grade IV and nine (23.7%) grade V.

DISCUSSION: In our study we found that de novo VUR is several times more common in patients treated with electrosurgical incision. This is the main difference between two described endoscopic procedures. Although this is a relatively new surgical technique, and other authors had similar results, which implies the importance of laser fenestration in the prevention of VUR in neonates with ureterocele.

CONCLUSION: The occurrence of VUR is significantly lower in neonatal patients treated with holmium-laser fenestration, compared to standard electrosurgical incision, although both techniques are highly effective in relieving the obstruction.

Since the use of this technique reduces the incidence of VUR, the need for subsequent surgery is lower in patients treated with holmium-laser.