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In vitro evaluation of a novel pediatric flexible cystoscope - A practical comparison of endoscopes for pediatric lower urinary tract evaluation
Hong Truong, MD1, Victor Kucherov, MD1, Jennifer Hagerty, DO2, Jose Rosado, CST2, Scott Hubosky, MD1, Demetrius Bagley, MD1.
1Thomas Jefferson University Hospital, PHILADELPHIA, PA, USA, 2Nemours/A.I. duPont Hospital for Children, Wilmington, DE, USA.



BACKGROUND
Adequate assessment of the lower urinary tract in patients post-reconstructive surgeries, such as bladder neck reconstruction and continent catheterizable channels, presents a unique challenge for pediatric urologists. There is a need for a flexible cystoscope specifically designed for children. Herein, we compare in vitro performance of a novel single-use pediatric flexible cystoscope with commonly used endoscopes for pediatric cystoscopy.
METHODS
We compared technical factors that affect surgical utilities including optics, deflection, and irrigation flow of a single-use Neoflex pediatric flexible cystoscope (Neoscope, USA), a Gyrus ACMI pediatric semi-rigid cystoscope (Olympus, USA), Flex-X2 flexible ureteroscope (Karl Storz, Germany), and an adult flexible cystoscope (Karl Storz, Germany).
RESULTS
The technical characteristics are shown in Table 1. Neoflex has wider field of view (85) than Storz cystoscope (80), Flex-X2 (75), and Gyrus ACMI (40). Neoflex has the best angle and diameter of deflection with and without instruments in the working channel (p<0.03). Neoflex provides the highest image resolution compared to the other scopes at all distances tested (p<0.0001). The color quality of each scope depends on the distance the scopes were positioned away from the target. Overall, Gyrus ACMI and Storz cystoscopes have highest color representation. Neoflex has the lowest color quality (p<0.0001). Gyrus ACMI has the highest irrigation flow with an empty working channel, followed by Storz cystoscope, Neoflex, and Flex-X2 at 286, 256, 65, and 42mL/min respectively. With the 1.9F basket, the Storz cystoscope has more superior flow rate compared to Gyrus ACMI, Neoflex, and Flex-X2 (Table 1).
CONCLUSIONS
The Neoflex single-use pediatric cystoscope is the only flexible cystoscope in the market designed for children. Neoflex outperforms available scopes used for pediatric cystoscopy in terms of image resolution, field of view, and deflection capacity. The Gyrus ACMI pediatric semi-rigid cystoscope is superior in irrigation and color quality. A flexible cystoscope designed with pediatric specifications enhance lower urinary tract evaluation in children with bladder reconstruction and add to pediatric urologists′ armamentarium.


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