Novel Use of an Infant Cystoscope for Pediatric Ureteroscopy/ Застосування цистоскопу для новонароджених для дитячої уретерореноскопії

Hubert S. Swana, MD; Arvind R. Krishnan, BA; Mark A. Rich, MD

University of Central Florida School of Medicine

Objectives: The incidence of pediatric stone disease is increasing. Ureteroscopy in children is challenging due to the smaller caliber of the ureter. We present a video demonstrating the novel use of a 4.5/6-Fr, 0° newborn blunt needle tip cystoscope for cystoureteroscopy and laser lithotripsy in children with symptomatic distal ureteral stones.

Methods: In both cases young boys presented with abdominal pain, nausea and vomiting. They were found to have distal ureteral stones. In each case, a 4.5-6.5-Fr infant cystoscope was used to perform cystoscopy and retrograde ureteropyelography. This was followed by placement of a 0.025 PTFE safety guide wire. Using the same cystoscope,ureteroscopy was then performed. The cystoscope was passed alongside the wire through the ureterovesical junction to access and visualize the stones. A Holmium:YAG laser and 200 micron fiber were then used to fragment the stones. A 1.9-Fr nitonol stone retrieval basket was used to easily remove the stone fragments which were sent for crystallographic analysis.

Results: Both patients were rendered stone-free following the procedures. There was no need for balloon dilation of the ureterovesical junction. No intraoperative or postoperative complications were encountered.

Conclusions: The use of an infant cystoscope for ureteroscopy in children is a useful addition to a urologist’s endoscopic practice. The shorter length allows for easier manipulation of ureteral catheters, wires, laser fibers, baskets, and graspers. This technique can reduce the risk of ureteral injury by allowing passage through the ureterovesical junction without the need for dilation.