39 A sterile disposable sheath system for flexible cystoscopes

Abstract

Introduction: Flexible cystourethroscopy is a routine procedure in urology. Sterilization of instruments is time‐consuming and may damage flexible instruments but is essential to prevent contamination. This study is the first to document experience using a flexible cystoscope with a disposable sheath as an alternative to sterilization in a urological setting.Methods: Two hundred consecutive patients (172 men; 28 women) had flexible cystourethroscopy performed in an office setting using flexible endoscopes with disposable sheaths (Endosheath System, Vision‐Sciences Inc, Natick, MA) using a standardised procedure. Cystoscopies were performed for surveillance of bladder carcinoma (107), haematuria for investigation (59), lower urinary tract voiding systems (16), removal of stent (12), assessment of urethral stricture (5) and removal of calculus (1). Costings were calculated comparing a session using standard cystoscopes for ten procedures to the first ten procedures with this disposable sheath system.Results: There were no breaches of the sheath or contamination of the cystoscope and no infections recorded. There were nine technical failures with the disposable sheath system due to an inability to insert the cystoscope easily using the sheath, but these all occurred in the first one hundred procedures. Costings were comparable.Conclusions: Potential advantages of a disposable sheath system include eliminating sterilizing of the cystoscope between patients, saving staff time and minimising exposure to hazardous cleaning and sterilizing preparations. Costs are comparable but there is a learning curve for placing the instrument within the sheath. Endoscopes with disposable sheaths are safe, comply with universal precautions and are an alternative to current instrumentation and sterilizing systems.