Cold knife valvulotomy for posterior urethral valves using novel optical urethrotome.
OBJECTIVE
To present our results after valve ablation using a novel cold knife urethrotome.


METHODS
Eleven consecutive male patients with posterior urethral valves underwent cold knife valvulotomy using a modified optical pediatric urethrotome. Patients were assessed both pre- and postoperatively using serum creatinine, voiding cystourethrography, and renal/bladder ultrasonography.


RESULTS
From August 2003 to August 2005, 11 patients underwent cold knife valvulotomy, of whom 7 returned for postoperative follow-up (mean follow-up 17.4 months). At surgery, the patients ranged in age from 5 days to 9 years. At presentation, 5 of the 7 patients had an elevated serum creatinine (mean 2.5 mg/dL, range 0.3-6.5), all had bilateral hydronephrosis of at least grade 3, and 6 of 7 had at least grade 3 reflux on 1 side. Intraoperatively, 1 complication (minor urethral laceration) occurred. Postoperatively, all 6 patients with serum creatinine levels measured showed improvement in renal function (mean creatinine 0.47 mg/dL, range 0.2-0.9). For the 6 patients who underwent postoperative ultrasonography, 4 had either complete resolution or significant improvement in their hydronephrosis, and none showed worsening. Six patients underwent postoperative voiding cystourethrography, with 5 showing either marked improvement or complete resolution of their reflux and 1 showing stable, unilateral reflux.


CONCLUSIONS
Valvulotomy using our modified urethrotome is a safe and effective technique for valve ablation.
Barber
Theodore
T
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA. Theodore.Barber@UTSouthwestern.edu
Al-Omar
Osama
O
McLorie
Gordon A
GA
D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003452:Cryosurgery / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D004869:Equipment Safety; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000517:prevention & control; D007223:Infant; D007231:Infant, Newborn; D007677:Kidney Function Tests; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D013523:Surgical Equipment; D016896:Treatment Outcome; D014521:Urethra / Q000002:abnormalities* / Q000601:surgery*; D014563:Urodynamics; D014564:Urogenital Abnormalities / Q000175:diagnosis / Q000601:surgery*
D003404:Creatinine