1072 In vivo and ex vivo comparison of optics and performance of a novel dual channel fiberoptic ureteroscope

Abstract

INTRODUCTION AND OBJECTIVES: Flexible ureteroscopy has become a standard for the treatment of small renal calculi. Ureteroscopic equipment has a well-documented limited lifespan prior to need for maintenance. The most common location and etiology of scope damage is due to passing or misfiring a laser fiber in the working channel of a flexible ureteroscope. Conventional laser fibers utilize a blunt tip that can be difficult to pass through a deflected scope, and can potentially result in damage. A new laser fiber has become commercially available with a ball-shaped output tip. This is proposed to pass more easily through a fully deflected ureteroscope in an atraumatic manner. Our objective was to evaluate the use of this ball-tipped fiber and its effect on the incidence and cost of ureteroscope repairs. METHODS: Our institution began using the single-use ball-tipped fibers in January 2013. We retrospectively reviewed the charts of the first 80 patients undergoing ureteroscopy with laser lithotripsy utilizing the ball-tipped laser fiber, and compared them to the 80 patients immediately prior to the switch, where a reusable blunt tip fiber was utilized. We collected basic patient demographics, as well as stone location, stone size, type of ureteroscope used, use of a ureteral access sheath, total operative time, and energy used for lithotripsy. Repair data of the flexible ureteroscopes, including cost and type of damage was obtained. Pertinent repair costs included those related to damaged working channels. A cost analysis was performed to see if decrease ureteroscope repair cost justified the increase cost of the single use ball-tip fiber. RESULTS: During the review period, 58 patients underwent flexible ureteroscopy with the traditional blunt tip laser fiber and 60 patients with the ball tip fiber. There was no significant difference in patient age, stone burden, or operative time between the two groups. During use of the blunt tip fiber there were 5 repairs to working channels, incurring a cost of $28,018, while 2 working channel repairs, costing $12,408 were attributed to use of the ball-tipped fiber. Accounting for the increased cost of the ball tipped fiber of $195 per use, it was associated with a net savings of $81.27 per case. CONCLUSIONS: The use of a ball tipped laser fiber during flexible ureteroscopy with laser lithotripsy may be associated less frequent working channel repairs, and a modest cost savings.