Ablation of Diaphragmatic Annular Ureteral Valve with Holmium Laser

Abstract

We report laser ablation of a diaphragmatic ureteral valve. Annular diaphragmatic ureteral valves are a rare cause of ureteral obstruction. We believe this to be the first reported case of laser ablation of a ureteral valve. Follow-up at 2 years revealed preserved renal function and unobstructed drainage.

Ureteral Valve Masquerading as Obstructive Megaureter

“…Other methods involve endoscopic incision of the valve or use of Holmium laser via ureteroscope to ablate ureteric valve [5].…”

Holmium laser ablation: a successful treatment option for an obstructing ureteric valve

“…1 The most common presentation of this condition includes flank pain, gross hematuria and urinary infection. 1,3,7 In one reported case, a non-functioning kidney was found on initial investigation which required a nephrectomy. 6 Various reports suggest that initial investigations, such as excretory urography and a CT scan, were able to demonstrate ureteric obstruction with hydronephrosis, but the cause of obstruction could not be established; a definitive diagnosis could only be made by retrograde pyelography and ureteroscopy.…”

“…6 Various reports suggest that initial investigations, such as excretory urography and a CT scan, were able to demonstrate ureteric obstruction with hydronephrosis, but the cause of obstruction could not be established; a definitive diagnosis could only be made by retrograde pyelography and ureteroscopy. 1,3,7 Ureteric strictures, whether acquired or congenital, remain another common cause of ureteric obstruction and should be ruled out. A ureteric stricture is defined as a constantly narrowed segment of a ureter.…”

“…7 Other minimally invasive treatment options described include the removal of the valve with biopsy pens without resection 3 and the endoscopic incision with a hook-shaped cold knife on the dorsal side of the ureter. 8 Ureteric valve causing significant obstruction could also be surgically excised with primary ureteroureteral anastomosis or ureteropyelostomy.…”

Hidronefrosis prenatal secundaria a válvulas ureterales

“…El tratamiento quirú rgico consiste en la escisió n quirú rgica del segmento que contiene la vá lvula y en la anastomosis té rmino-terminal. No obstante, el desarrollo de té cnicas mínimamente invasivas, como el tratamiento endoscó pico, llevando a cabo escisiones o ablaciones con lá ser de la vá lvula ureteral, han sido utilizados con buenos resultados 6,7 . En nuestro caso, el uso de estas té cnicas mínimamente invasivas, tal y como fue la dilatació n neumá tica, permitió resolver exitosamente la reestenosis postoperatoria, evitando de este modo una nueva intervenció n quirú rgica así como una mayor morbilidad asociada a una nueva intervenció n 8 .…”