King George's Medical University, Lucknow, India.
Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
Lasers Med Sci. 2021 Apr;36(3):521-528. doi: 10.1007/s10103-020-03051-w. Epub 2020 Jun 3.
Transurethral endoscopic incision is an established treatment option for management of obstructing ureterocele. It can be performed using monopolar electrocautery or holmium laser as an energy source. The present study was carried out to evaluate outcomes of transurethral ureterocele incision (TUI) by two different energy sources, i.e., monopolar electrocautery versus holmium laser. A retrospective review of the data of all patients who underwent endoscopic TUI from 2007-2017 was performed. Preoperative clinical, biochemical, and radiological characteristics and operative parameters were reviewed and compared between the two groups. Associated stone in the ureterocele was fragmented using pneumatic lithotripter or Mauermeyer stone punch forceps in the electrocautery group and holmium laser in the laser group. Statistical analysis was performed using IBM SPSS version 21.0. Chi-squared test was used for categorical/dichotomous variables. Unpaired t test was used for continuous variables. Out of total 44 patients, 28 patients had duplex system ureterocele and 16 patients had single system ureterocele. Mean age was 18.5 + 7.4 years (range 14-26 years). Six patients had associated stones in the ureterocele. Most common presentation was flank pain followed by urinary infections and bladder outlet obstruction. Preoperative vesico-ureteric reflux was seen in 18% patients. Monopolar TUI was performed in 20 patients and laser-TUI in 24 patients. Three patients had associated stone in ureterocele in each group. Fragmentation of stone was successfully done with holmium laser without changing the instrument and with less associated surgical morbidity in the laser group. Postoperative successful decompression was evident in 38 (90%) patients. Renal parenchyma thickness was improved on ultrasound scan and renal scan showed non-obstructed system in all patients at follow-up. Both laser and monopolar incision have similar efficacy in decompressing the ureterocele in long-term follow-up. However, laser has added advantage of stone lithotripsy with the same instruments with lesser morbidity and lower incidence of persistent reflux.
经尿道内镜切开术是治疗梗阻性输尿管口囊肿的一种既定治疗选择。它可以使用单极电切或钬激光作为能源进行。本研究旨在评估两种不同能源（单极电切与钬激光）经尿道输尿管口囊肿切开术（TUI）的结果。对 2007 年至 2017 年间所有接受内镜 TUI 治疗的患者数据进行回顾性分析。比较两组患者的术前临床、生化和影像学特征及手术参数。输尿管口囊肿内的结石用气压弹道碎石器或 Mauermeyer 石冲钳在电切组粉碎，用钬激光在激光组粉碎。使用 IBM SPSS 版本 21.0 进行统计分析。使用卡方检验进行分类/二项变量。使用未配对 t 检验进行连续变量。在总共 44 名患者中，28 名患者为双系统输尿管口囊肿，16 名患者为单系统输尿管口囊肿。平均年龄为 18.5+7.4 岁（范围 14-26 岁）。6 名患者的输尿管口囊肿内有结石。最常见的表现是腰痛，其次是尿路感染和膀胱出口梗阻。18%的患者术前有膀胱输尿管反流。20 名患者行单极 TUI，24 名患者行激光-TUI。两组各有 3 名患者的输尿管口囊肿内有结石。激光组用钬激光成功碎石，无需更换器械，手术相关并发症较少。38 名（90%）患者术后减压成功。超声检查显示肾实质厚度改善，肾扫描显示所有患者在随访时均为无梗阻系统。在长期随访中，激光和单极切开术在缓解输尿管口囊肿方面具有相似的疗效。然而，激光具有结石碎石的额外优势，可使用相同的器械，且发病率较低，持续性反流发生率较低。
