Skip to main content
SpringerLink
Log in

Comparison of electrocautery versus holmium laser energy source for transurethral ureterocele incision: an outcome analysis from a tertiary care institute

  • Original Article
  • Published:
Lasers in Medical Science Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Ilic P, Jankovic M, Milickovic M, Dzambasanovic S, Kojovic V (2018) Laser-puncture versus electrosurgery-incision of the ureterocele in neonatal patients. Urol J 15(2):27–32

    PubMed  Google Scholar 

  2. Singh SJ, Smith G (2001) Effectiveness of primary endoscopic incision of ureteroceles. Pediatr Surg Int 17(7):528–531

    Article  CAS  Google Scholar 

  3. Byun E, Merguerian PA (2006) A meta-analysis of surgical practice patterns in the endoscopic management of ureteroceles. J Urol 176:1871

    Article  Google Scholar 

  4. Shah HN, Sodha H, Khandkar AA, Kharodawala S, Hegde SS, Bansal M (2008) Endoscopic management of adult orthotopic ureterocele and associated calculi with holmium laser: experience with 16 patients over 4 years and review of literature. J Endourol 22(3):489–496

    Article  Google Scholar 

  5. Derouiche A, Belhaj K, Feki W, Zaafrani R, Chebil M (2007) Place of endoscopic treatment of complicated ureteroceles in adults. Prog Urol 17(7):1362–1366 French

    Article  Google Scholar 

  6. Shekarriz B, Upadhyay J, Fleming P, González R, Barthold JS (1999) Long-term outcome based on the initial surgical approach to ureterocele. J Urol 162:1072–1076

    Article  CAS  Google Scholar 

  7. Blyth B, Passerini-Glazel G, Camuffo C, Snyder HM 3rd, Duckett JW (1993) Endoscopic incision of ureteroceles: intravesical versus ectopic. J Urol 149(3):556–559

    Article  CAS  Google Scholar 

  8. Westesson KE, Goldman HB (2013) Prolapse of a single-system ureterocele causing urinary retention in an adult woman. Int Urogynecol J 24(10):1761–1763

    Article  Google Scholar 

  9. Singh I (2007) Adult bilateral non-obstructing orthotopicureteroceles with multiplecalculi: endoscopic management with review of literature. Int Urol Nephrol 39(1):71–74

    Article  Google Scholar 

  10. Han MY, Gibbons MD, Belman AB, Pohl HG, Majd M, Rushton HG (2005) Indications for nonoperative management of ureteroceles. J Urol 174:1652–1655

    Article  Google Scholar 

  11. Glassberg KI, Braren V, Duckett JW, Jacobs EC, King LR, Lebowitz RL et al (1984) Suggested terminology for duplex systems, ectopic ureters and ureteroceles. J Urol 132(6):1153–1154

    Article  CAS  Google Scholar 

  12. Chertin B, Mohanan N, Farkas A, Puri P (2007) Endoscopic treatment of vesicoureteralreflux associated with ureterocele. J Urol 178:1594–1597

    Article  Google Scholar 

  13. Marr L, Skoog SJ (2002) Laser incision of ureterocele in the pediatric patient. J Urol 167(1):280–282

    Article  Google Scholar 

  14. Coplen DE, Duckett JW (1995) The modern approach to ureteroceles. J Urol 153(1):166–171 Review

    Article  CAS  Google Scholar 

  15. Pesce C, Musi L, Campobasso P, Belloli G (1998) Endoscopic and minimal open surgical incision of ureteroceles. Pediatr Surg Int 13:277

    Article  CAS  Google Scholar 

  16. Pfister C, Ravasse P, Barret E, Petit T, Mitrofanoff P (1998) The value of endoscopic treatment for ureteroceles during the neonatal period. J Urol 159:1006

    Article  CAS  Google Scholar 

  17. Vijay MK, Vijay P, Dutta A, Gupta A, Tiwari P, Kumar S et al (2011) The safety and efficacy of endoscopic incision of orthotopic ureterocele in adult. Saudi J Kidney Dis Transpl 22(6):1169–1174

    PubMed  Google Scholar 

  18. Jayanthi VR, Koff SA (1999) Long-term outcome of transurethral puncture of ectopic ureterocele: initial success and late problems. J Urol 162:1077

    Article  CAS  Google Scholar 

  19. Viville C (1990) Endoscopic treatment of ureterocele and antireflux injection with Teflon paste. Eur Urol 17:321

    Article  CAS  Google Scholar 

Download references

Acknowledgments

The authors acknowledge the cooperation of residents of the Urology Department of King George’s Medical University who participated in data collection and evaluation of the patient. We also appreciate the commitment and compliance of the patient who reported the required data.

Author information

Authors and Affiliations

  1. King George’s Medical University, Lucknow, India

    Ashish Sharma, Gaurav Garg, Manoj Kumar & S. N. Sankhwar

  2. Department of Urology, King George’s Medical University, Lucknow, Uttar Pradesh, 226003, India

    Ashish Sharma

  3. Rajiv Gandhi Superspeciality Hospital, Delhi, India

    Anamika Sharma

Authors
  1. Ashish Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gaurav Garg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anamika Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Manoj Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. N. Sankhwar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

1. Dr. Ashish Sharma—Concept, design, supervision, processing, writing manuscript, and critical analysis.

2. Dr. Gaurav Garg—Concept, design, supervision, processing, writing manuscript, and critical analysis.

3. Dr. Anamika Sharma—Writing manuscript, critical analysis, and statistical analysis.

4. Dr. Manoj Kumar—Concept, design, supervision, processing, writing manuscript, and critical analysis.

5. Dr. S N Sankhwar—Concept, supervision, writing manuscript, and critical analysis.

Corresponding author

Correspondence to Ashish Sharma.

Ethics declarations

Informed consent

Written informed consent was obtained from the all the patients/relatives.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sharma, A., Garg, G., Sharma, A. et al. Comparison of electrocautery versus holmium laser energy source for transurethral ureterocele incision: an outcome analysis from a tertiary care institute. Lasers Med Sci 36, 521–528 (2021). https://doi.org/10.1007/s10103-020-03051-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10103-020-03051-w

Keywords

Search

Navigation