Pediatric ureteroscopy: 16-year-old with cystinuria

‘Y’tube is a video resource for urologists and other physicians who focus on men’s health. This installment focuses on pediatric ureteroscopy. It features videos from Jonathan S. Ellison, MD, Michael P. Kurtz, MD, MPH/Caleb P. Nelson, MD, and Pankaj P. Dangle, MD. Commentary for these videos is provided by Gregory Tasian MD, MSc, MSCE, and 'Y'tube Section Editor James M. Hotaling, MD, MS.

This video of bilateral ureteroscopy in a 16-year-old male with cystinuria highlights several pragmatic strategies for efficient ureteroscopy while minimizing ionizing radiation.

Considerations for treatment strategies, use of safety wires, and follow-up imaging are also discussed.

Dr. Tasian: Dr. Ellison provides an excellent video demonstrating the considerations for retrograde intrarenal surgery in pediatric patients, drawing particular attention to the importance of minimizing radiation and anesthetics. These include optimizing fluoroscopy settings, using ultrasound as the preferred diagnostic imaging modality, and performing a bilateral ureteroscopy with judicious use of ureteral stents on a string. These practices are even more important for children with cystinuria who are almost certain to have many operations and countless imaging studies over their lifetime, as suggested by the multifocal subendothelial crystallization in each kidney.

Dr. Hotaling: Dr. Ellison demonstrates how many of the techniques originally developed for adults can be employed by skilled pediatric endourologists. His deliberate choice to limit radiation, employ ultrasound where possible, and complete a bilateral procedure with one anesthetic are relevant to both adult and pediatric endourologists looking to optimize outcomes.

Dr. Ellison is assistant professor of urology in the division of pediatric urology at the Medical College of Wisconsin and Children’s Hospital of Wisconsin, Milwaukee.

Gregory Tasian, MD, MSc, MSCE

Section Editor James M. Hotaling, MD, MS

Dr. Tasian is assistant professor of urology and epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, and Dr. Hotaling is assistant professor of surgery (urology) at the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City.