Holmium laser ablation of anterior urethral valves: case report.

PURPOSE: To report a novel method for treating anterior urethral valves in children using the holmium:YAG laser. CASE REPORT: A 2-year-old boy presented with symptoms of urinary-outflow obstruction. A micturating cystourethrogram (MCUG) revealed an abrupt narrowing of the penile urethra. At cystourethroscopy, an anterior urethral valve without a diverticulum was visible. This was ablated endoscopically using the Ho:YAG laser. The child voided successfully and was discharged the next day. Repeat MCUG 6 months later revealed a normal-caliber urethra. CONCLUSION: Holmium:YAG laser ablation of anterior valves is a minimally invasive treatment modality that provided a satisfactory result and appears to be very promising.

Ureteric calculi in children: preliminary experience with holmium:YAG laser lithotripsy.

OBJECTIVE: To determine the efficacy and safety of holmium:YAG laser lithotripsy in children with ureteric calculi. PATIENTS AND METHODS: Between 1999 and 2003, 28 ureteroscopic laser procedures were carried out on 26 children (14 boys and 12 girls, mean age 6.5 years) with ureteric calculi. The mean (range) stone size was 1.21 (0.4-2.2) cm. At ureteroscopy the calculi were in the upper ureter in six (23%), mid-ureter in five (19%) and lower ureter in 15 (58%) patients. A rigid 8 F ureteroscope was used and the Ho:YAG laser energy delivered at 0.6-1.4 J and 6-10 Hz. All patients were evaluated after 3 months with intravenous urography to confirm stone clearance and to exclude ureteric stricture formation. RESULTS: The overall stone-free rate was 92% (24 children) after 28 ureteroscopic procedures. Stones were completely cleared in 83%, 80% and 100% of the procedures in the upper, mid- and lower ureters, respectively. In two children the procedure failed; they were salvaged by ureterolithotomy in one and extracorporeal shockwave lithotripsy in the other. During the procedures, a ureteric perforation was caused by several factors, including a technically difficult procedure and higher laser energy. At the mean (range) follow-up of 18 (3-39) months, low grade vesico-ureteric reflux was detected in two children, and there were no ureteric strictures in any. CONCLUSION: Holmium:YAG laser lithotripsy is an efficient and safe treatment for ureteric calculi in children.