The goal of endoscopic incision of ureteroceles is to decompress the ureterocele in a minimally invasive manner while minimizing the risk of postincision vesicoureteral reflux and the need for further urinary tract reconstruction (4). This technique can be used in infants, if infant-sized endoscopic equipment is available, and should be used to drain obstructive urinary systems in any ureterocele patient with urosepsis. Blyth and coauthors (5) recommended the use of a 3Fr Bugbee wire electrode (using the cutting current) to incise the roof of the ureterocele through its full thickness near its base and proximal to the bladder neck. A new unobstructed intravesical ureteral orifice will be created, and the roof of the collapsed ureterocele can act as a flap-valve mechanism to prevent reflux. Although the Bugbee electrode has been a widely used instrument for ureterocele puncture, it has limitations, primarily that following initial decompression enlargement of the puncture site is difficult. Therefore, we prefer to use the pediatric resectoscope and the right-angle hook electrode with the cutting current, which allows one to make a clean transverse incision and enlarge it by placing the hook into the original incision and withdrawing under vision (Fig. 94.2). Magnification with the use of video projection helps improve the accuracy of the incision. Making the incision as distal and as close to the bladder neck as possible should reduce the risk of postoperative reflux into the corresponding ureter. The adequacy of the incision can be confirmed by the presence of a jet of urine from the ureterocele or by visualization of the urothelium inside the ureterocele. The major advantage of the endoscopic incision is that it can be done on an outpatient basis without the need for hospitalization. Other energy sources, such as a laser, have also been described as an alternative method of endoscopic incision (6).