The researchers compare the holmium-laser puncture and electrosurgery-incision in neonates with intravesical ureterocele. Prenatal and postnatal ultrasound investigation, magnetic resonance imaging, radionuclide renal scan and voiding cystourethrogram (VCUG) are procedures used to define a complex anatomy of the urinary tract of these patients, but the final diagnostic procedure is endoscopy.
Surgical treatment of ureterocele in neonatal period has to be performed to eliminate the obstruction and urinary tract infection (UTI) and to avoid the occurrence of vesicoureteral reflux, and, also, to preserve renal function and prevent urinary incontinence. The overall procedural morbidity has to be minimized.
The options for the treatment are transurethral incision, excision of ureterocele with (or without) ureterocystoneostomy or ureteroureterostomy, upper pole haeminephroureterectomy.
Transurethral incision or puncture of the ureterocele may prevent the obstruction and vesicoureteral reflux in majority of patients. Also, the necessity for subsequent surgery can be minimized. The endoscopic surgical treatment can be performed with electrosurgery, cold-knife and holmium-laser.
Researchers retrospectively analyzed the results of laser-puncture of ureterocele (LP group) in 12 patients (mean age 9.8 days, range 4-28) and electrosurgery-incision in 20 patients (ES group) (mean age 10.2 days, range 6-28), treated at our institution. Patients had their records reviewed for preoperative findings, endoscopic procedure description, and postoperative outcomes.
There was the need for retreatment in one (8.3%) patient in LP group and in four (20%) patients in ES group (P = .626). Duration of general anesthesia in LP and ES groups was 16 (range, 10-24) minutes and 15 (range,10-20) minutes, respectively (P = .355). There was no statistically significant difference in terms of hospitalization (LF group one day, ES group 1.35 days) (P = .286). Complications were not found in LP group.
There were two (10%) patients with pyelonephritis after the treatment in ES group (P = .516). After one month, obstruction was observed on ultarsound examination in one (8.3%) and two (10%) patients, respectively. After three months, obstruction was not found in any patient in both groups. After six months, vesicoureteral reflux was found in one (8.3%) patient after laser-puncture of the ureterocele and in 13 (65%) patients after electrosurgery-incision (P = .003).
Both laser-puncture and electrosurgery-incision endoscopic techniques are highly effective in relieving the obstruction. There is no significant difference regarding hospitalization, need for retreatment and the occurrence of complications. The incidence of de novo vesicoureteral reflux is significantly lower in patients treated with holmium-laser, as well as the need for upper pole partial nephrectomy.