Urethral stricture constitutes a important complication of transurethral approach of valves ablation. It occurs up to 50% of cases and it is mainly due to urethral trauma of instrumentation. The accessibility of miniature endoscope results in a decreased incidence of urethral stricture. Urethral stricture may occur because of thermal burn from the diathermy for fulguration, i.e., electro-coagulation of urethral tissue or heat is generated when electric current pass through glycine or water during fulguration.
PROCEDURE:
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Diagnosed to have PUV by a test called voiding cystourethrogram (VCUG) underwent cystoscopy on a day-care surgery performed under general anesthesia.
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The diagnosis was established and Nd: YAG laser fulguration of the PUV was done. The treatment was performed under lithotomy position by using the Wolf 8.5 cystoscope and the 25° telescope.
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This angled telescope will helps to keep the laser beam below visual control all through the fulguration. After identifying the valves, the 600µ quartz bare fibers of the laser is passed from the side channel of the cystoscope and bring in direct contact with the valves then it was fulgurated.
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The bare fiber was bring in the contact with a central portion of the valves that was then vaporized by advancing centrifugally. The laser power setting range from 25-30 Watts and the total energy was delivered every time ranging from 160-756 Joules, with a mean of 316 Joules.
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No effort was made to vaporize the valves all around totally to reduce the chances of laser injury to the nearby structures. The sufficiency of the fulguration was checked in the operating theater by observing the urinary stream.
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Historical controls consisted of patients with PUV (n=50) who have undergone cystoscopy and electro-coagulation of the valves in the time period.
