Holmium laser ablation (HOLA) of posterior urethral valves in preterm newborns.

INTRODUCTION

We report our experience with Holmium Laser Ablation (HOLA) of posterior urethral valves (PUV) in preterm newborns.

METHODS/TECHNIQUE: After stabilization under anesthesia, in lithotomy position, using a 4.5/6.5 compact cystoscope (Richard Wolf) & 365-micron fibre, laser was applied at 2 J/10 Hz for HOLA. The valve leaflets were divided by short bursts of laser energy (video) joining the dots to provide complete clearance. A repeat VCUG and cystoscopy was performed in all patients after 3-6 months to confirm clearance. All patients were followed up for a median duration of 5 years (range 3-9 years). Biochemical, radiological and bladder parameters were followed up.

RESULTS

Between 2015 and 2025, 22 neonates; median gestation 34 weeks; [32,36] underwent HOLA of PUV. Successful clearance of PUV was achieved in 20/22 neonates (90.9%), as confirmed by repeat VCUG/cystoscopy. Renal function improved significantly (p = 0.001), with the median (IQR) creatinine level decreasing from 2.6 (1,3) pre-fulguration to 0.9 (0.7,1.2) at the one-year follow-up. Upper tract dilatation persisted in seven, subsequent urodynamic evaluation identified bladder; all were successfully managed with anticholinergic medication.

CONCLUSION

HOLA of PUV is feasible in preterm neonates with acceptable short-term complication profile, and without apparent excess morbidity in this small cohort.