EXPERIENCE WITH URETEROSCOPY IN CHILDREN”.PPT

15 children underwent 21 Ureteroscopic procedures 19 Retrograde (Semi -Rigid Urs Flex. Urs ) 2 Antegrade (Flex. Urs) ( PERIOD - 1989 - 1994 ) . Age - 13 months to 14 year Weight - Mean 35.9 kgs (range from 7 to 70 Kgs). Height - Mean 127.2 CMS (range from 70 to 162 cms) Lyon and his associates were the first to develop a pur pose built 13F Ureteroscope 21 ureteroscopic procedures: 18 were for stone disease 2 for haematuria of unknown origin 1 for removal of a migrated stent In 1979 Goodman used paediatric cystoscope (11F) for 3 adult ureteroscopy Dilatation of Ureteric orifice was required only in 1/21 Ureteroscopic procedure ( Dilatation for Retrograde 9.5 Fr Flexible Ureteroscope ) 10/13 Children with stone Disease required SINGLE ureteroscopy 3/13 Children with Stone Disease required NINE ureteroscopies All the children underwent : Routine biochemistry Urine-culture Full metabolic screen for stone disease KUB -X-ray US All the procedures were performed under GENERAL anaesthesia Muscle paralysis for stones in the LUMBAR ureter Technique of ureteroscopy in children similar to ADULTS FLEXIBLE URETEROSCOPE Haematuria of Unknown Origin - Flexible 9.5F ureteroscope used retrogradely ( To inspect URETER CALYCES of kidney) For Re-implanted ureter - antegrade approach through 12F Nephrostomy for lower third stone FLEXIBLE URETEROSCOPE USEFUL SCOPE FOR ANTEGRADE URETEROSCOPY . Routine prophylactic antibiotics Gentamicin - one dose ( appropriate to the body wt.) All the procedures viewed on video camera rather than directly through the eyepiece Fluoroscopic monitoring was made available Video camera helped to perfect upper endoscopic procedures IMPROVED OVERALL RESULTS TECHNIQUE OF URETEROSCOPY………... Ureteroscope rotated hence guidewire faces superio-laterally Ureteric meatus Opens up due to stretching of Orifice. Once Intramural Ureter entered the Ureteroscope Rotated back in alignment with ureter T