title: Holmium: yttrium-aluminum-garnet laser puncture of ureteroceles in neonatal period.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Pediatric Urology, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Jankowski
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Palmer
mesh_terms: D019299:Decompression, Surgical / Q000009:adverse effects; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D053685:Laser Therapy / Q000009:adverse effects; D008297:Male; D011677:Punctures; D014518:Ureterocele / Q000151:congenital* / Q000601:surgery*