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Ablation of posterior urethral valves in the newborn using Fogarty balloon catheter: A simple method for developing
1Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
Purpose:
The aim of this study was to review the efficacy and safety of using a Fogarty balloon catheter to ablate posterior urethral valves (PUV) in the newborn in a developing country.
Methods:
Five newborn babies weighing 1.4 to 3.9 kg (mean, 2.08 kg; with 4 weighing less than 2.0 kg) who had severe obstructive uropathy caused by PUV were subjected to valve ablation using a size 6F Fogarty balloon catheter in the radiology department without anesthesia. The ages ranged from 10 to 61 days (mean, 26.4 days) at the time of valve ablation.
Results:
Successful ablation of PUV was achieved in 4 of 5 (80%) patients after one attempt at ablation. There was failure to ablate the PUV in 1 patient despite 2 attempts to do so. All 4 patients with successful ablation of PUV had grade IV vesicoureteric reflux (VUR) before valve ablation. Postablation micturating cystourethrogram (MCU) showed complete disappearance of VUR in one child. In 2, VUR improved to grade III and II immediately after valve ablation, and further improved to grade I and 0, respectively, at MCU repeated 3 months later. In one child, grade IV VUR persisted during the postablation VUR and remained at that grade 3 months later.
Conclusions:
Fogarty balloon catheter ablation of PUV is an effective, economic, and simple alternative to endoscopic valve fulguration in very sick and small neonates. It is particularly suitable for use in developing countries in which expensive endoscopes may not be readily available.