Neodymium:YAG laser incision of congenital obstructive posterior urethral membrane in boys with urinary incontinence and low uroflow

Background and Purpose: Congenital obstructive posterior urethral membrane (COPUM) is associated with subclinical lower urinary tract symptoms in boys. Urethral stricture following cystoscopic fulguration of the membrane and a relatively small urethral caliber make the treatment of this condition difficult. Methods: Fifteen boys (mean age, 10.0 years) with COPUM were treated with neodymium:YAG (Nd:YAG) contact laser incision of the membrane through a cystourethroscope (n = 7) or a ureteroscope (n = 8). Results: Presenting symptoms were bedtime incontinence in 15, frequency/urgency in 10, daytime incontinence in 7, lazy bladder in 3 and urinary tract infection in 2. All patients had an obstructive urinary flow pattern with a maximal flow rate (Q_max) <15 mL/s. The mean follow-up period was 10.5 months. After the surgery, the number of wet nights per week reduced >90%, 50-90% and <50% in 9 (60%), 5 (33.3%), and 1 (6.7%), respectively. Mean (Q_max) increased from 11.3 to 14.9 mL/s (p = 0.003). Conclusion: Nd:YAG laser incision of COPUM with the aid of a ureteroscope or a cystourethroscope is a safe and effective method for improving urinary flow and bedtime incontinence.