HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

Laser ablation in the management of obstructive uropathy in neonates.

AbstractINTRODUCTION:
Endoscopic management of posterior urethral valves and congenital ureteroceles is the current standard to relieve the obstruction. While the most commonly used techniques involve cystoscopic incision with cold knife or electrosurgery, an alternative is to ablate the obstructive tissue with laser energy. With increasing prenatal diagnoses, there has been an increasing shift in the timing of intervention toward earlier periods. The literature contains only two reports of laser ablation in neonates for these disease entities.
MATERIALS AND METHODS:
A case series was conducted by retrospectively reviewing our surgical database for all consecutive infants <28 days old (i.e., neonates) diagnosed in utero with obstructive uropathy and with postnatal imaging consistent with either urethral valves (anterior or posterior) or ureterocele. Holmium: yttrium aluminum-garnet (Ho:YAG) laser ablation was used as the exclusive modality of endoscopic management during the study period. All patients were followed with voiding cystourethrogram and renal/bladder ultrasounds postoperatively.
RESULTS:
Seventeen neonates underwent retrograde transurethral laser ablation procedures at a median age of 7 days (range 3-27). There were nine cases of urethral valve ablation (seven posterior, two anterior) and eight ureterocele ablations. Median operative time was 23 minutes (range 18-33). There were no intraoperative complications or reoperative procedures required for any case. All patients voided after postoperative catheter removal, and no patient had evidence of residual valve tissue or urethral stricture at mean follow-up of 10.1 months. All patients with ureterocele demonstrated partial or complete decompression of the ureterocele and improvement in hydroureteronephrosis at 3 months.
CONCLUSIONS:
Ho:YAG laser ablation appears safe, effective, and efficient for the management of urethral valves and ureteroceles in the neonatal period. With a continuing trend toward early definitive intervention for these conditions, laser ablation remains an important alternative to electrosurgery in this population.
AuthorsMatthew J Pagano, Jason P van Batavia, Pasquale Casale
JournalJournal of endourology (J Endourol) Vol. 29 Issue 5 Pg. 611-4 (May 2015) ISSN: 1557-900X [Electronic] United States
PMID25046584 (Publication Type: Clinical Study, Journal Article)
Topics
  • Cohort Studies
  • Cystoscopy (methods)
  • Female
  • Humans
  • Hydronephrosis (etiology, surgery)
  • Infant, Newborn
  • Laser Therapy (methods)
  • Lasers, Solid-State (therapeutic use)
  • Male
  • Retrospective Studies
  • Treatment Outcome
  • Ureterocele (surgery)
  • Urethral Obstruction (complications, surgery)
  • Urethral Stricture (complications, surgery)

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: