Advantages of fulguration of posterior urethral valves by Nd: YAG laser

Abstract

Posterior Urethral Valves (PUV) are one of the com-monest urolgical problems seen in children and the electro-coagulation, which is the most widely preferred modality to ablate the valves, may not be feasible in small-for-date and low-birth-weight neonates as the suitable size resec-toscope/cystoscope may not available. With the availa-bility of Nd: YAG laser at our institute recently, we started performing the laser fulguration instead of electrocoagu-lation of the valves. We reviewed our experience with the emerging role of the Nd: YAG laser in the fulguration of PUV, comparing the results with a historical control group who underwent the classical electrocoagulation of the PUV. The boys (n=50) diagnosed to have PUV by VCUG were confirmed by Wolf 8.5 size cystoscope, underwent Nd: YAG laser fulguration of the valves with a bare fiber, as a day-care procedure without postoperative catheteri-zation. Historical controls (n=50) who had undergone classical electrocoagulation using 9.5 size Wolf resectos-cope served as the controls. The mean age was 1.3 y and 2.6 y in laser and electrocoagulation group respectively. The mean hospital stay of the electrocoagulation group was 3.8 d. Three patients after electrocoagulation devel-oped hematuria and 4 required refulguration whereas in the laser group 5 required refulguration and none devel-oped hematuria. In conclusion, endoscopic laser fulgura-tion of PUV is technically feasible even in neonates and small children. Laser offers excellent results that are com-parable to the time-honored electrocoagulation procedure. This has the additional advantage forfulgurating the PUV in smaller caliber urethra as this can be performed with the smaller available cystoscope that has a side channel, admitting the laser fiber.

Keywords

• Urethral Valve; Child; Laser; Electrocoagulation; Complication.