Laser Therapy Leads to Serious Complications!

0
Complications of laser therapy
Voiding cystourethrography showing contrast leak around the bladder on the right side.

Complications after a transurethral laser incision in a 6-week-old baby boy with simple ureterocele.

A 6-week-old male presented with general bad health and clinical manifestation of sepsis 2 days after laser incision of a simple right ureterocele using a holmium laser. The baby underwent endoscopic incision in the outpatient department. Thereafter, the boy was discharged home immediately after cystoscopy.

The baby underwent an ultrasound which showed mild distention of the right renal collecting system and upper part of the right ureter. Moreover, US also showed a fluid collection around the bladder.

Voiding Cystourethrography (VCUG) suggested contrast leak localized paravesically.

Computed Tomographic Urography (CTU) revealed a dilated right collecting system. It also showed partially visible right ureter and contrast leak from its distal end above the bladder.

CTU

Cystoscopy showed necrosis of the right bladder wall.

Cystoscopy: necrotic right bladder wall

The doctors decided to perform a laparotomy. Intraoperatively, they discovered a completely destroyed right bladder wall with a perforation (locally coagulated and buried tissues). Moreover, they also found damage of the distal 3-4 cm of the right ureter. Above the bladder, approximately 4 to 5 cm above, the ureter was healthy. Additionally, the anterior wall of the rectum was also involved, however, there was no perforation in the rectal wall. but without perforation.

 After removal of damaged tissues, the surgeons closed the bladder in layers. Finally, they performed right end ureterocutaneostomy.

Postoperative course:

Postoperatively, the patient had no immediate complications. Control Computed Tomographic Urography (CTU) revealed no leak in the urinary tract.

However, radionuclide examination showed right renal parenchyma scarring with slightly diminished function (45% ERPF).

During the first 2 months after the surgery, the patient developed recurrent Urinary Tract Infections (UTI). Moreover, the cutaneous orifice of end ureterocutaneostomy showed progressive stenosis. Therefore, the stenosis required reoperation with excision of distal scarred part of the ureter followed by more proximal localization of stomy.

laser therapy complication
Stenosis of cutaneous orifice
Scarred distal ureter

Following the second surgery, there were no complication. In the following 4 years, ureterostomy functioned perfectly, there were no dilatation of the right collecting system and the patient didn’t develop any UTIs.

During recent years, for simple ureterocele in neonates and young children, holmium: YAG laser has become the first line of treatment. It is proven to be safe and efficacious without any intraoperative complications. This case describes a first-time reported complication of laser therapy. Therefore, it also highlights the importance of being aware of the complications so that one is careful while opting and using the new techniques for endoscopic treatment.

References:

Warchol S, Dudek T (2017) Serious Complication after Laser Treatment of Ureterocele in an Infant. Int Arch Urol Complic 3:028. doi.org/10.23937/2469-5742/1510028

World Hepatitis Day 2021
Previous articleCT Scan Reveals Toothpick in Rectum
Next article3-Year-Old’s Face Disappears On MRI
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

LEAVE A REPLY

Please enter your comment!
Please enter your name here