The reused-disposable scope in flexible ureteroscopy for stones as a cost-conscious approach: Reporting the outcomes of a real-world practice multicenter study of 2183 patients by the team of worldwide endourological researchers group

Abstract

ABSTRACT Introduction: We aimed to assess complications and stone-free rate of flexible ureteroscopy (FU) reusing disposable scopes (RDS) after repeated sterilization. Methods: Data from adults from 11 centers were retrospectively reviewed (January 2020–December 2022). Inclusion criteria were proximal ureteral/renal stone(s). All cases were performed using an RDS to save costs for patients who come from economically challenged environments. Residual fragments (RFs) were defined as single fragment ≥4 mm or multiple fragments of any size within 3 months. Continuous variables are presented as median and interquartile range. Results: Two thousand one hundred and eighty-three patients were included, of whom 67.0% were male. Median age was 48.0 (36–59) years. The median stone diameter was 10.2 (9–14) mm. Flash sterilization was used in 90.2% (plasma in 60.5%). Approximately, 88% had FU with an RDS used ≤2 times (12%: 3–5 times). RDS needed to be changed intraoperatively in 3.9% of cases due to its malfunction. Commonly, defects in RDS function were reported in upward (1.6%) and downward deflection (6.5%) and image quality on white balancing (4.7%). Fever >38C was seen in 13.7% of cases, and sepsis in 0.5%. RFs were found in 31.4% of cases. Lower pole (odds ratio [OR] 5.63) or pelvis stone (OR 4.67), faulty scopes (OR 12.8), and total operation time (OR 1.05) were factors associated with higher odds of RFs. Stone size (OR 1.09), positive urine culture (OR 1.67), interpolar stone (OR 1.68), and prestenting (OR 1.37) were factors associated with higher odds of fever/sepsis. Conclusions: RDS was used as a cost-conscious approach with a low rate of serious infections but with a high rate of RFs.