Posterior Urethral Valves (PUV) are one of the commonest urolgical problems seen in children and the electrocoagulation, 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 resectoscope/cystoscope may not available. With the availability of Nd: YAG laser at our institute recently, we started performing the laser fulguration instead of electrocoagulation 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 catheterization. Historical controls (n=50) who had undergone classical electrocoagulation using 9.5 size Wolf resectoscope 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 developed hematuria and 4 required refulguration whereas in the laser group 5 required refulguration and none developed hematuria. In conclusion, endoscopic laser fulguration of PUV is technically feasible even in neonates and small children. Laser offers excellent results that are comparable 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.
TreatmentIt can be done by Endoscopic laser Fulguration Surgery.
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