USE OF HOLMIUM: YTTRIUM-ALUMINUM-GARNET LASER FOR ENDOSCOPIC DECOMPRESSION OF URETEROCELE: IS IT SAFE ALTERNATIVE TO ELECTROSURGERY

Dr Deepak Kumar; Dr Susanta Tripathy; Dr Amit Agrawal

Volume : IX, Issue : VI, June - 2020

USE OF HOLMIUM: YTTRIUM-ALUMINUM-GARNET LASER FOR ENDOSCOPIC DECOMPRESSION OF URETEROCELE: IS IT SAFE ALTERNATIVE TO ELECTROSURGERY

Dr Deepak Kumar, Dr Susanta Tripathy, Dr Amit Agrawal

Abstract :

Introduction: Few case series report the use of holmium: yttrium–aluminum–garnet (Ho:YAG) laser to decompress ureterocele (UC) in pediatric and adult population, and only two studies compared its outcomes with electrosurgery. This study aims to compare outcomes of Ho:YAG laser transurethral endoscopic incision (LTUI) versus electrocautery transurethral endoscopic incision (ETUI) of UC. We also analyse incidence of secondary surgery, redo trans urethral incision (TUI) and iatrogenic vesicoureteral reflux (VUR). Patients and Methods: A prospective study of patients treated by TUI of UC from Jan 2016 to Jan 2020 was performed. Those undergoing Ho:YAG laser TUI were included in Group A, those undergoing electrocautery TUI were included in Group B. Data were compared using Fisher�s exact test. Results: Group A included seven patients . Two required a redo TUI. Two had preoperative VUR, which resolved after TUI. Two developed VUR after TUI, which resolved spontaneously. No secondary surgery was required. Group B included nine patients. One required a redo TUI. Preoperative VUR was detected in 4/9 and persisted after TUI in 2. Three developed post–TUI VUR, which persisted. Five required further surgery because of persistent and symptomatic VUR. Secondary surgery was significantly lower after Ho:YAG laser compared to electrocautery TUI (P < 0.05). The incidences of both redo TUI and postoperative VUR were not significantly different between the two groups (P = ns). Conclusion: Ho:YAG laser TUI seems to be safe and effective in the decompression of obstructive UCs and maybe advantageous over electrocautery puncture. However, further studies with larger cohort are needed to corroborate our preliminary results.