Endoscopic Use of Lasers in Pediatric Urology

Abstract

Background: Advances in technology have made the urinary tract of small children more accessible to endourologic examination and intervention. Parallel advances in laser technology have complemented these developments, allowing ablative energy to be delivered through the small working ports of pediatric and infant cytoscopes. Patients and Methods: We report our experience with KTP laser treatment of posterior urethral valves (PUV) in 20 patients, ureteroceles in 9, and urethral strictures in 4. Results: All PUV ablations were successful, with no postoperative stricture formation. All ureterocele excisions were technically successful, although three patients subsequently required surgery for nonfunctioning upper poles, and one required ureteral reimplantation. All stricture incisions were unsuccessful, with open urethroplasty required by 2 years. An additional three patients, including one with a stone in a ureterocele, underwent holmium laser lithotripsy without complications and are stone free. Recently, we have changed to the holmium laser for ureteroceles and PUV in three patients, with encouraging early results. Conclusion: As we move increasingly toward minimally invasive surgery to decrease both patient morbidity and treatment costs, we can expect further innovative applications of both endourologic and laser technology in pediatric urology.