Jankowski Jason T, Palmer Jeffrey S
Division of Pediatric Urology, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.
Urology. 2006 Jul;68(1):179-81. doi: 10.1016/j.urology.2006.01.066. Epub 2006 Jun 27.
The use of the holmium:yttrium-aluminum-garnet (YAG) laser to incise a ureterocele in children has been reported. However, its use to puncture ureteroceles in neonates has not. Therefore, we evaluated the effectiveness and safety of ureterocele puncture using a holmium-YAG laser in neonatal patients.
We reviewed our experience of all neonates (ie, children younger than 28 days old) who underwent transurethral puncture of a ureterocele. The preoperative data collected included age at presentation, mode of presentation, ureterocele location, and weight and age at the procedure. A holmium:YAG laser was used to incise the ureterocele, and a 200, 365, or 550-microm laser fiber was passed through a 6F or 7.5F cystoscope.
A total of 4 neonates (2 boys and 2 girls) underwent transurethral holmium laser puncture of five ureteroceles. All patients were initially diagnosed with prenatal ultrasound findings confirmed after birth with additional imaging. The mean age at the initial puncture was 13.8 days, with a mean patient weight of 3.9 kg. The mean follow-up was 2.8 years (range 1.7 to 3.4). Four (80%) of five ureteroceles were adequately decompressed after one attempt. One patient required a second puncture of the ureterocele at 46 days of age because of incomplete decompression. None of the patients experienced an intraoperative or postoperative complication, including new vesicoureteral reflux after laser puncture.
Holmium:YAG laser puncture of ureterocele is a safe, efficacious, and viable option for children in the neonatal period. However, this technique in these young children requires additional evaluation.
钬：钇铝石榴石（YAG）激光用于切开儿童输尿管囊肿已有报道。然而，其用于穿刺新生儿输尿管囊肿的情况尚未见报道。因此，我们评估了在新生儿患者中使用钬-YAG激光穿刺输尿管囊肿的有效性和安全性。
我们回顾了所有接受输尿管囊肿经尿道穿刺的新生儿（即28日龄以下儿童）的经验。收集的术前数据包括就诊时年龄、就诊方式、输尿管囊肿位置以及手术时的体重和年龄。使用钬：YAG激光切开输尿管囊肿，将200、365或550微米的激光光纤通过6F或7.5F膀胱镜。
共有4例新生儿（2男2女）接受了对5个输尿管囊肿的经尿道钬激光穿刺。所有患者最初均经产前超声诊断，出生后经额外影像学检查得以证实。首次穿刺时的平均年龄为13.8天，患者平均体重为3.9千克。平均随访时间为2.8年（范围1.7至3.4年）。5个输尿管囊肿中有4个（80%）在一次穿刺后得到充分减压。1例患者因减压不完全，在46日龄时需要对输尿管囊肿进行第二次穿刺。所有患者均未出现术中或术后并发症，包括激光穿刺后新出现的膀胱输尿管反流。
钬：YAG激光穿刺输尿管囊肿对于新生儿期儿童是一种安全、有效且可行的选择。然而，对于这些幼儿，这项技术需要进一步评估。
