URETHROSCOPY IN SMALL NEONATES WITH POSTERIOR URETHRAL VALVES AND URETEROSCOPY IN CHILDREN WITH URETERAL CALCULI

Objectives. To describe our recent experience using a 6.9F cytoscope i n the fulguration of posterior urethral valves (PUVs) in premature neo nates and distal ureteroscopy with stone extraction in children. Metho ds. Fulguration of PUVs was performed in 3 premature neonates born at 34 to 36 weeks' gestation with weights of 2480 to 2900 g. The PUVs wer e fulgurated during a single endoscopic procedure using a 6.9F cystosc ope and a 3F bugbie electrode. In addition, 11 children (8 girls, 3 bo ys; mean age, 11.1 years; range 5 to 16) with symptomatic calculi unde rwent 15 distal ureteroscopic procedures using the 6.9F cystoscope. Re sults. In the neonates with fulguration of PUVs, vesicostomy, the only reasonable alternative, was avoided, and each infant now voids with a n excellent stream 3 to 16 months later, without evidence of stricture or residual valves;ln the children with distal ureteroscopy, the uret eral calculi were retrieved using a 3F four-wire stone basket. With on e exception, distal ureteroscopy was performed without dilation of the ureteral orifice. Extracorporeal shock-wave lithotripsy (ESWL) was no t recommended because of stone position and difficult radiographic vis ualization. Nine children were rendered stone free with one procedure. Two procedures were required in 1 child and three in another. In both cases, ureteral edema was present, and the stone was embedded in the ureteral wall. One child underwent separate procedures for bilateral c alculi. In all cases general anesthesia was used, with a mean duration of 65 minutes (range 28 to 96). Temporary ureteral stenting was perfo rmed in 10 (93%) patients,and 9 (81%) were discharged home on the same day or the next morning. A mean follow-up period of 8.5 months (range , 0.5 to 22) has failed to show any problems related to ureteral stric ture or injury. Conclusions. Endoscopic fulguration of PUVs is now pos sible in small neonates and is minimally invasive compared with vesico stomy; Distal ureteroscopy with stone retrieval should be considered i n children, especially those with calculi that are not suitable for ES WL.