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

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



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, 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).
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.

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Zeng L, Huang G, Zhang J, et al. A new classification of duplex kidney based on kidney morphology and management. Chin Med J. 2013;126:615-9.

Schultza K, Todab LY. Genetic Basis of Ureterocele. Curr Genomics. 2016; 17:62-9.

Hodhod A, Jednak R, Khriguian J, El-Sherbiny M. Transurethral incision of ureterocele: Does the time of presentation affect the need for further surgical interventions? J Pediatr Urol. 2017 Mar 18. pii: S1477-5131(17)30106-7. doi: 10.1016/j.jpurol.2017.02.016. [Epub ahead of print]

Moriya K, Nakamura M, Nishimura Y, et al. Prevalence of and risk factors for symptomatic urinary tract infection after endoscopic incision for the treatment of ureterocele in children. BJU Int. 2017 Apr 22. doi: 10.1111/bju.13884. [Epub ahead of print]

Maizels M, Liu D, Gong EM, Kaplan WE, Cheng EY. Endoscopic ureterocele-otomy-Retrograde incision from orifice (RIO) of

urethral segment of ureterocele and extending to bladder neck is a feasible and simple procedure. J Pediatr Urol. 2016;12:137-8.

Chalouhi G, Morency AM, De Vlieger R, et al. Prenatal incision of ureterocele causing bladder outlet obstruction - A multicenter

case series. Prenat Diagn. 2017 Jun 27. doi: 10.1002/pd.5091. [Epub ahead of print]

Gander R, Asensio M, Royo GF, Lloret J. Evaluation of the initial treatment of ureteroceles. Urology. 2016;89:113-7.

Visuri S, Jahnukainen T, Taskinen S. Prenatal complicated duplex collecting system and ureterocele-Important risk factors for urinary tract infection. J Pediatr Surg. 2017 May 11. pii: S0022-3468(17)30272-5. doi: 10.1016/j.

jpedsurg.2017.05.007. [Epub ahead of print]

Faure A, Merrot T, Sala Q, et al. Value of diagnosis imaging in the evaluation of the severity of histological lesions in duplex

systems. J Pediatr Urol. 2014;10:361-7.

Chowdhary SK, Kandpal DK, Sibal A, Srivastava RN, Vasudev AS. Ureterocele in newborns, infants and children: Ten year

prospective study with primary endoscopic deroofing and double J (DJ) stenting. J Pediatr Surg. 2017;52:569-73.

Rodrigues I, Estevão-Costa J, Fragoso AC. Complete ureteral duplication: outcome of different surgical approaches. Acta Med Port. 2016;29:275-8.

Gutiérrez JM, Ortega M, Ardela E, Lorenzo G, Martin Pinto F. Endoscopic incision of intravesical ureteroceles in patients with duplex system. Cir Pediatr. 2014;27:107-9.

Cohen SA, Juwono T, Palazzi KL, Kaplan GW, Chiang G. Examining trends in the treatment of ureterocele yields no definitive solution. J Pediatr Urol. 2015;11:29.

Persico N, Berettini A, Fabietti I, et al. A new minimally invasive technique for cystoscopic laser treatment of fetal ureterocele. Ultrasound Obstet Gynecol. 2016 Sep 8. doi: 10.1002/uog.17296. [Epub ahead of print].

Torres Montebruno X, Martinez JM, Eixarch E, et al. Fetoscopic laser surgery to decompress distal urethral obstruction caused by prolapsed ureterocele. Ultrasound Obstet Gynecol. 2015;46:623-6.

Timberlake MD, Corbett ST. Minimally invasive techniques for management of the ureterocele and ectopic ureter: upper tract

versus lower tract approach. Urol Clin North Am. 2015;42:61-76.

Chowdhary SK, Kandpal DK, Sibal A, Srivastava RN. Management of complicated ureteroceles: Different modalities of treatment and long-term outcome. J Indian Assoc Pediatr

Surg. 2014;19:156-61.

Sander JC, Bilgutay AN, Stanasel I. Outcomes of endoscopic incision for the treatment of ureterocele in children at a single institution. J Urol. 2015;193:662-6.

Palmer BW, Greger H, Mannas BP, Kropp BP, Frimberger D. Comparison of endoscopic ureterocele decompression techniques.

Preliminary experience – is the watering can puncture superior? J Urol. 2011;186:1700-3.

Pagano MJ, van Batavia JP, Casale P. Laser ablation in the management of obstructive uropathy in neonates. J Endourol. 2015;29:611-4.

Godinho AB, Nunes C, Janeiro M, Carvalho R, Melo MA, da Graca LM. Ureterocele: antenatal diagnosis and management. Fetal Diagn Ther. 2013;34:188-91.

Haddad J, Meenakshi-Sundaram B, Rademaker N, et al. "Watering Can" ureterocele puncture technique leads to decreased rates of de novo vesicoureteral reflux and subsequent surgery with durable results. Urology. 2017 Jun 15. pii: S0090-4295(17)30621-0. doi: 10.1016/j. urology.2017.06.008. [Epub ahead of print]

Dada SA, Rafiu MO, Olanrewaju TO. Chronic renal failure in a patient with bilateral ureterocele. Saudi Med J. 2015;36:862-4.

Penkoff P, Bariol S. Urethral calculus originating from ureterocele and causing urinary retention. ANZ J Surg. 2015;85:892-3.

Castagnetti M, Vidal E, Burei M, Zucchetta P, Murer L, Rigamonti W. Duplex system ureterocele in infants: should we reconsider the indications for secondary surgery after endoscopic puncture or partial nephrectomy? J Pediatr Urol. 2013;9:11-6.

Hisamatsu E, Takagi S, Nakagawa Y, Sugita Y. Nephrectomy and upper pole heminephrectomy for poorly functioning kidney: Is total ureterectomy necessary? Indian J Urol. 2012;28:271-4.

Swana HS, Hakky TS, Rich MA. Transurethral neo-orifice (TUNO) a novel technique for management of upper pole obstruction in infancy. Int Braz J Urol. 2013;39:143.

Sofer M, Binyamini J, Ekstein PM, et al. Holmium laser ureteroscopic treatment of various pathologic features in pediatrics. Urology. 2007;69:566-9.

Atis G, Gurbuz C, Arikan O, Canat L, Kilic M, Caskurlu T. Ureteroscopic management with laser lithotripsy of renal pelvic stones. J Endourol. 2012;26:983-7.

Ilic P, Djordjevic M, Kojovic V, Dzambasanovic S. Laser lithotripsy in the treatment of renal stones in children. A singlecenter experience. Ann Ital Chir. 2016;87:326-32.


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