Ureterocele fenestration with holmium laser in neonates.

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. KEY WORDS: Fenestration, Holmium-laser, Neonates, Ureterocele.

Laser-puncture Versus Electrosurgery-incision of the Ureterocele in Neonatal Patients.

PURPOSE: To compare the holmium-laser puncture and electrosurgery-incision in neonates with intravesical ureterocele. MATERIALS AND METHODS: We 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. RESULTS: 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, obstructionwas 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). CONCLUSION: 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.

Laser lithotripsy in the treatment of renal stones in children. A single-center experience.

AIM: To evaluate the effectiveness and safety of laser lithotripsy in the treatment of renal stones in children in a single center. MATERIAL AND METHODS: We retrospectively analysed patients (n=36) who were treated with laser nephrolithotripsy (LL group) between 2011 and 2014. We compared those results with results of pneumatic nephrolithotripsy in patients (n=32) who were treated from 2007 to 2011 (PL group). The patients were evaluated in respect of gender, age, stone location, stone size, complications and stone-free rate. RESULTS: The duration of anesthesia, the need for retreatment, the mean hospitalization and the occurrence of minor complications (perirenal haematoma, urinoma, minimal ureteral perforation) were significantly lower in LL group (p < 0.05). We found statistically significant difference in stone-free rate between two groups - stone-free rate was significantly higher in LL group (LL: 94.4% vs. PL: 62.5%) (p < 0.05). DISCUSSION: Analyzing the stone-free rate after lithotripsy and the occurrence of complications, it is shown that the laser lithotripsy is more efficient than pneumatic lithotripsy and that endoscopic procedure proved safer, in terms of complications. Majority of the studies showed different successful rate after laser lithotripsy for stones located in the kidney. In particular cases, there is the need for ureteral orifice dilatation and ureteral stent insertion. CONCLUSIONS: Laser endoscopic lithotripsy is minimally invasive, effective and safe surgical procedure for the treatment of renal stones in children with minimal complication rate. The effectiveness is partially limited to stones in lower pole calices of the kidney. KEY WORDS: Laser lithotripsy, Urolithiasis, Ureterorenoscopy.