Ovunda Jack Omodu, S. Eli, Chinwendu Okengwu and D. G. B. Kalio
ABSTRACT
Background: Posterior urethral valve (PUV) accounts for 20–40% of end-stage renal diseases in children. It is the most common cause of bladder outlet obstruction in infancy that impair renal and bladder function. Endoscopic PUV ablation is however not commonly practiced in Port Harcourt. Prenatal diagnosis and early surgical intervention improves the outcome.
Objective: This study was planned to establish our experience in the use of a holmium laser in the treatment of PUV in Colworths Medical Centre.
Patients and Methods: This study was a prospective study of endoscopic PUV treatments carried out in Colworths Medical Centre between November 2015 and April 2019. Information obtained include age, diagnosis, procedure, duration of surgery, and complications and were analyzed. All operations were done with the patient under general anesthesia. Holmium laser surgery for PUV using a 550 quartz bare fiber through the catheter channel of an 8.5°F cystoscope. The laser power and total energy delivered ranged from 20 to 50 W and 50 to 1085 J, respectively.
Results: During the period of study, 25 babies with age range of 10 months–5 years who were diagnosed with PUV following clinical and radiological evaluations had the endoscopic valve treatment using the holmium laser to incise the valve at 5 and 7 o’clock positions. All the patients had a pre-operative cystoscopy check. Twenty-four patients had good stream at immediate post-operative period and disappearance of the valve after micturating cystourethrogram (MCU). One baby had a recurrence and needed a second surgery resulting in good urinary stream with post-operative MCU showing complete disappearance of the valve.W
Conclusion: Endoscopic posterior valve ablation using a holmium laser is a safe procedure and is regularly performed in Port Harcourt, Nigeria, with satisfactory results.
Key words: Holmium laser, micturating cystourethrogram, posterior urethral valve, posterior urethral valve