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Laser incision of ureterocele in the pediatric patient
1Division of Urology, Oregon Health Sciences University, Portland, OR, USA.
Insights
Initial laser incision effectively decompresses ureteroceles in children, relieving obstruction and preventing infection. This minimally invasive treatment is a viable first-line option for most ureterocele cases.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Endourology
Background:
- Ureteroceles are congenital cystic dilatations of the distal ureter.
- Urinary tract obstruction and infection are common complications.
- Surgical intervention is often required to manage ureteroceles.
Purpose of the Study:
- To evaluate the efficacy of initial laser transurethral incision of ureterocele.
- To assess its effectiveness in relieving obstruction and preventing infection.
- To determine the need for subsequent surgical procedures.
Main Methods:
- Retrospective review of 30 children with ureterocele treated between 1995 and 2000.
- Analysis of medical records and imaging studies for 14 children who underwent initial transurethral laser incision.
- Evaluation of presentation, ureterocele characteristics, and outcomes including infection, reflux, renal function, and need for further surgery.
Main Results:
- All patients achieved ureterocele and upper tract decompression with one laser incision.
- The risk of urinary tract infection post-incision was low.
- Vesicoureteral reflux persisted or developed in most cases, with no spontaneous resolution.
- Upper pole renal function was preserved in 82% of patients.
- 28% of patients required only the initial laser incision, while 36% underwent definitive surgery.
Conclusions:
- Endoscopic laser incision provides precise decompression of ureteroceles in a single treatment.
- Laser incision is a safe and effective initial management option for most pediatric ureteroceles.
- It offers a minimally invasive approach with good functional outcomes.
Purpose:
We evaluated the effectiveness of initial laser transurethral incision of ureterocele for relieving obstruction, prevention of infection and need for subsequent surgery.
Materials And Methods:
We reviewed the medical records and imaging studies of 30 children with ureterocele treated between 1995 and 2000. Of 30 children 14 underwent initial transurethral laser incision of the ureterocele. Records and images were evaluated for mode of presentation, ureterocele location, thickness, and decompression, and relief of obstruction. The incidence of urinary tract infection, new onset vesicoureteral reflux, upper segment renal function and need for subsequent surgery after incision was investigated.
Results:
There were 5 boys and 9 girls in our series. Mean patient age at presentation was 17.5 months. There were 12 patients who had ectopic and 2 orthotopic ureteroceles. Ureterocele was defined as thick if ultrasound measurement was 4 mm. or greater. Thick ureterocele was present in 4 (28%) patients. All patients had ultrasound evidence of decompression of the ureterocele and upper tract with 1 treatment. Urinary infection risk was 0.015 per month of followup after incision. Vesicoureteral reflux was present in 8 of 12 (67%) ectopic systems before incision and 9 of 10 (90%) after. None had resolved reflux during followup. Upper pole renal function was assessed by renal scan and/or renal ultrasound. Upper pole function or increased cortical thickness was documented in 9 of 11 (82%) patients. Endoscopic laser incision was the only treatment required in 4 of 14 (28%) patients, including 2 with orthotopic and 2 ectopic ureteroceles. Of 14 patients 5 (36%) had undergone definitive surgery and 5 were followed.
Conclusions:
Endoscopic laser incision of ureterocele allows a precise incision and decompression of the ureterocele with 1 treatment. Laser incision of ureterocele should be considered as the initial treatment in most patients.
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