Empty Working Channel Research Articles

Comparison of irrigation flows between different irrigation methods for flexible ureteroscopy: An in vitro study

To compare the irrigation flows between different irrigation methods for f-URS. We compared the automatic irrigation system Endoflow II to gravity-based irrigation, and gravity-based irrigation with pressure cuff. Irrigation pressures were set at 40 and 100cmH2O. A LithoVue f-URS with a 3.6Fr working channel was used for the experiments. The f-URS was placed in straight alignment without active deflection on the operating table. For each irrigation pressure level, we evaluated the influence of the occupation of the working channel of the f-URS with an empty working channel, a 272μm laser fiber, a 1.9Fr nitinol basket. The outflow from f-URS was measured by the volume of irrigation fluid collected using a graduated glass at 1min, 2min, 3min and 5min. Irrigations flows remained constant over the time for the Endoflow II and the gravity-based irrigation methods regardless of the irrigation pressure and setting. For the pressure cuff method, the irrigation flow remained constant only when the working channel was occupied either by the nitinol basket or the laser fiber. Irrigation flow with the Endoflow II were constantly higher than gravity-based irrigation methods. Irrigation flow significantly increased with increased irrigation pressure. In the presence of any instruments at any irrigation pressure, the flow decreased as the size of the instrument in the working channel increased. Automatic irrigation system Endoflow II provided higher irrigation flows than gravity-based irrigation methods. The irrigation flow decreased as the size of the instrument in the working channel increased. Further studies conducted in vivo are needed to investigate if the differences found between irrigation methods result in higher intrarenal pressure during procedures. 4.

Single-use flexible ureteroscopes: Comparative in vitro analysis of four scopes

ObjectiveSingle-use flexible ureteroscopes (fURSs) have recently been introduced by different companies. Goal of this in-vitro study was to compare four fURSs. MethodsWe performed in vitro analysis of Uscope 7.5 Fr and Uscope 9.5 Fr (Pusen Ltd., Zhuhai, China), LithoVue 9.5 Fr (LithoVue™, Boston Scientific, MA, USA), and Indoscope 9.5 Fr (Bioradmedisys™, Pune, India). Optical characteristics (image resolution, color representation, and luminosity) were compared at various distances of 10 mm, 20 mm, and 50 mm. Deflection and irrigation were evaluated with and without accessories. ResultsColor perception was comparable for all scopes at 10 mm (p<0.05), while Lithovue 9.5 Fr was comparable with Indoscope 9.5 Fr at the distances of 20 mm and 50 mm. Both scopes were statistically better than both Uscopes at the distances of 20 mm and 50 mm. Image resolution powers were comparable amongst all fURSs at the distances of 10 mm and 20 mm (3.56 line pairs per millimeter [lp/mm]). However, Indoscope (3.56 lp/mm) was superior to LithoVue and Uscope scopes (3.17 lp/mm) at the distance of 50 mm. Luminosity at the distance of 10 mm was comparable for LithoVue and Uscope 9.5 Fr. However, at the distances of 20 mm and 50 mm, LithoVue had the highest luminosity while Uscope 7.5 Fr had the lowest one. Indoscope had lower luminosity than other 9.5 Fr scopes at all distances. With empty working channel and 200 μm laser fiber, Indoscope had the maximum deflection (285°). With basket, Uscope 7.5 Fr had the maximum loss of deflection (30°) while Indoscope had no deflection loss. With empty working channel, all scopes had comparable irrigation flow rates in both deflected and undeflected state. Similarly, with 200 μm laser or basket, irrigation flow rates were comparable in all scopes. ConclusionColor representation was equivalent for Indoscope and LithoVue, while being better than Uscope 7.5 Fr and Uscope 9.5 Fr. Image resolution was comparable in all scopes at the distances of 10 mm and 20 mm. Beyond the distance of 10 mm, luminosity of LithoVue was the highest and that of Uscope 7.5 Fr was the lowest. Deflection loss was the minimum with Indoscope and the maximum with 7.5 Fr Uscope. Under all scenarios, irrigation flow rates were comparable in all scopes.

Evolution of Single-Use Urologic Endoscopy: Benchtop and Initial Clinical Assessment of a New Single-Use Flexible Cystoscope.

Introduction: Office cystoscopy is one of the most frequently performed procedures by a urologist. However, single-use cystoscopes remain quite undeveloped. Ambu® has developed single-use broncoscopes, rhinolaryngoscopes, and duodenoscopes. Recently, they released a single-use cystoscope. In this study, we performed a benchtop and an initial clinical assessment of the Ambu aScope™ (4) Cysto (aS4C) single-use cystoscope. Materials and Methods: Ten new, never-used aS4C single-use cystoscopes were assessed for optical performance, maximal tip flexion, and irrigation flow rate with empty working channel, 365 μm laser fiber, 0.035 in hydrophilic-tipped wire, 1.9F nitinol basket, and a 1.8 mm flexible stent grasper. All cystoscopes were then fully flexed 25 times in each direction, and maximal flexion angles were remeasured with and without instruments. Optical resolution, distortion, and depth of field were measured and compared with our reusable digital flexible cystoscopes. Assessment of clinical use was performed for inpatient bedside procedures using a Likert feedback survey and the NASA Task Load Index. Results: Maximal upward flexion exceeded 200° and 160° for all working instruments in upward and downward flexion. Downward flexion demonstrated different flexion between instrument groups in pre- and postcycling (p < 0.001). There was no clinical difference between the pre- and postcycling flexion. Flow rate decreased with increasing working instrument size (p < 0.001). The Olympus HD cystoscope resolution was superior at 3 and 5 mm distance, but not at other distances. The Ambu scope was superior to the Olympus SD scope at all distances except 3 mm. The aS4C had higher Likert scale survey scores for clinical use. Conclusions: The new Ambu single-use cystoscope demonstrates good flexion across instruments and comparable optics with reusable cystoscopes. In addition, initial inpatient bedside use of the aS4C and Monitor system compares favorably with the Olympus reusable cystoscope. Further testing in clinical scenarios such as hematuria, urothelial carcinoma, and operative endoscopy is warranted.

Benchtop Assessment of a New Single-Use Flexible Ureteroscope.

Introduction: Single-use flexible ureteroscopes are an increasingly popular alternative to reusable ureteroscopes. In this study, we performed a benchtop examination of the physical and optical properties of the new Dornier Axis™ (Webling, Germany) single-use ureteroscope. Methods: Ten new, never-used Dornier Axis ureteroscopes were assessed for optical performance, maximal tip deflection, and irrigation flow rate with an empty working channel and with insertion of 200 and 365 μm laser fibers, and a 1.9F nitinol basket. All ureteroscopes were then fully deflected 100 times in each direction, and maximal deflection angles were re-measured with and without instruments in the working channel. All measurements were performed in duplicate. In vitro optical testing for resolution, image distortion, and depth of field was performed and compared vs the LithoVue™ (Boston Scientific, Marlborough, MA) single-use ureteroscope. Statistical analyses using paired Wilcoxon rank-sum tests and Kruskal-Wallis multiple-group comparison tests were performed in R. Results: Median maximal deflection angles exceeded 300° in both directions before and after 100 full deflection cycles for all groups except the 365 μm laser fiber group. After 100 deflection cycles, there was no change in the majority of working instruments, except a decrease in upward flexion with an empty channel and 200 μm Moses™ laser fiber, and downward flexion with 200 μm Flexiva™ laser fiber (all <10°). After excluding the 365 μm fiber, there was no difference in multi-group comparison for upward and downward flexion pre- and post-cycling. Median flow rate through an empty channel was 48.0 mL/min, and it decreased significantly with all used instruments (p < 0.001). Compared with the LithoVue, the Axis demonstrated superior resolution at all tested distances and less distortion. Conclusions: The new Dornier Axis single-use ureteroscope demonstrates excellent tip deflection, which remains unchanged after 100 manual flexions in each direction. The Axis also demonstrates superior optical performance compared with the LithoVue in benchtop testing.

Evaluation of a Single-Use Flexible Cystoscope: A Multi-Institutional International Study.

Introduction: Acquisition costs and prohibitively expensive technical support for endoscope maintenance, repair, and reprocessing have deterred adoption of flexible cystoscopes by many urologists internationally. This study evaluated the performance of a novel single-use digital cystoscope that can directly connect to a laptop or computer monitor for visualization, obviating the need for a tower. Materials and Methods: The performance characteristics of flexible single-use cystoscopes (NeoScope) were prospectively evaluated vs a reusable flexible cystoscope (Olympus) in three clinical cases and two independent benchtop testing episodes in Canada. Cystoscope maneuverability, imaging, deflection, irrigation, and ease of use of instrumentation were investigated. Additional investigations were performed during clinical use in Zimbabwe (7 patients), Egypt (10 patients), and Dominica (5 patients). Results: Bench testing revealed smaller tip diameter (4.06 vs 6.09 mm) and shorter (35.4 vs 38 cm) single-use cystoscopes vs reusable cystoscopes. Deflection of the single-use scope was superior with an empty working channel (230 up/220 down) vs the reusable (195 up/95 down) but showed a more substantial decrease in deflection on placement of instruments including a grasper. Clinical use revealed satisfactory maneuverability, ease of use of instruments, deflection, and visualization. Conclusions: Benchtop testing performance of the single-use digital flexible cystoscopes was inferior compared with reusable digital cystoscopes. However, these single-use endoscopes offer adequate illumination, imaging, and maneuverability. Direct connection to any computer monitor allowed truly portable use, allowing for treatment of patients in a variety of clinical settings without the need for ancillary equipment.

Avoiding a Lemon: Performance Consistency of Single-Use Ureteroscopes

Single-use flexible ureteroscopes are increasingly popular because of high repair costs of reusable ureteroscopes. As new single-use ureteroscopes enter the market, the consistency of performance of these devices has been questioned. Our objective was to compare two single-use ureteroscopes: the Pusen PU3022a (Zhuhai Pusen) and the LithoVue (Boston Scientific) with emphasis on physical and optical performance consistency. Ten LithoVue and 10 Pusen ureteroscopes were evaluated in never-used condition. The following parameters were recorded: maximal tip deflection with an empty working channel, 200 μm laser fiber, and 1.9F basket; image resolution at 10, 20, and 50 mm; and irrigation flow rate; all ureteroscopes were then fully deflected for 200 cycles. Maximum deflection was remeasured. Mean values for each parameter were compared. To examine within-manufacturer consistency, the variance was calculated and an F-test performed to evaluate for equivalence. Both ureteroscopes provided max deflection over 270°. The Pusen flexed to a greater degree than LithoVue. The Pusen lost more deflection with a laser fiber in the working channel. LithoVue had higher resolution at 10 mm, but the ureteroscopes were similar at 20 and 50 mm. Although the working channel diameter is identical, irrigation flow was higher with the Pusen. However, its working channel was 7 cm shorter than LithoVue. After 200 cycles of deflections, LithoVue had less deflection loss, although one ureteroscope was excluded from analysis because of mechanical failure. Variability was minimal and not significant between manufacturers at all measured parameters. LithoVue and the newer PU3022a have similar "out-of-the-box" performance characteristics and seem durable. These two single-use flexible ureteroscopes performed consistently regardless of the manufacturer.

PD22-01 IN VITRO EVALUATION OF SINGLE-USE DIGITAL FLEXIBLE URETEROSCOPES: A PRACTICAL COMPARISON FOR A PATIENT-CENTERED APPROACH

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology II1 Apr 2018PD22-01 IN VITRO EVALUATION OF SINGLE-USE DIGITAL FLEXIBLE URETEROSCOPES: A PRACTICAL COMPARISON FOR A PATIENT-CENTERED APPROACH Giovanni Marchini, Carlos Batagello, Manoj Monga, Fabio Torricelli, Fabio Vicentini, Alexandre Danilovic, Miguel Srougi, William Nahas, and Eduardo Mazzucchi Giovanni MarchiniGiovanni Marchini More articles by this author , Carlos BatagelloCarlos Batagello More articles by this author , Manoj MongaManoj Monga More articles by this author , Fabio TorricelliFabio Torricelli More articles by this author , Fabio VicentiniFabio Vicentini More articles by this author , Alexandre DanilovicAlexandre Danilovic More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , William NahasWilliam Nahas More articles by this author , and Eduardo MazzucchiEduardo Mazzucchi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1169AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES to compare the manufacturing and in vitro performance characteristics of two single use flexible ureteroscopes with a permanent optical flexible ureteroscope. METHODS Two single-use flexible ureteroscopes, LithoVue (Boston Scientific, USA) and Pusen (1rs. generation; Zhuhai Pusen Medical Technology Company Limited, China) were tested and compared with a permanent Flex-X2 ureteroscope (Karl Storz, Germany) in terms of technical characteristics, optics, deflection mechanism and additional parameters which could potentially affect surgical technique. RESULTS Pusen was the lightest ureteroscope while the LithoVue had the longest working length. LithoVue had a higher resolution power than the other two ureteroscopes at all distances tested (p<0.001)(Fig1). Pusen showed higher resolution than Flex-X2 (p<0.01). Field of view was wider for LithoVue (87o), followed by Flex-X2 (85o) and Pusen (75o). Color representation was superior for Flex-X2 than LithoVue and then Pusen (Fig2). LithoVue outperformed Pusen and Flex-X2 for all settings with instruments in terms of deflection loss (p<0.01). Pusen had the highest irrigation flow (52ml/min) with an empty working channel (p<0.01) (Fig3). LithoVue and Pusen showed similar flow rates with a 200μm (21ml/min), 365μm laser fiber (7ml/min), and 1.3F basket (18ml/min), being superior to Flex-X2 (p<0.01). With the 1.9F basket, LithoVue had superior flow rate (7ml/min) than Pusen and Flex-X2 (p=0.01). CONCLUSIONS LithoVue outperformed the other ureteroscopes in terms of optical resolution, field of view, deflection capacity, and irrigation flow with larger instruments. Pusen is the lighter scope and showed better results in terms of irrigation when no instruments are in place. Flex-X2 was superior in terms of color representation. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e473-e474 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Giovanni Marchini More articles by this author Carlos Batagello More articles by this author Manoj Monga More articles by this author Fabio Torricelli More articles by this author Fabio Vicentini More articles by this author Alexandre Danilovic More articles by this author Miguel Srougi More articles by this author William Nahas More articles by this author Eduardo Mazzucchi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Comparison of OnabotulinumtoxinA Intradetrusor Injection Needle Performance with Modern Flexible Cystoscopes

Intradetrusor injection of onabotulinumtoxinA (BTX-A) can be performed with rigid or flexible cystoscopy. The primary aim of this study was to analyze irrigant flow rate and total angle of deflection for the intradetrusor injection needles used for flexible cystoscopic injection of BTX-A to see if any needle provided a technical advantage. Three commercially available intradetrusor injection needles were evaluated using two modern flexible cystourethroscopes. The three needles analyzed were the NBI070 (Coloplast, Minneapolis, MN), DIS200 (Laborie, Williston, VT), and NM-101C-0427/MAJ-565/MAJ-655 (Olympus, Center Valley, PA). Angles of deflection and irrigant flow rates were calculated with an empty working channel and each injection needle in the working channel of the two flexible cystoscopes. With the working channel empty, the Karl Storz 11272CU1 (KS) and Olympus CYF-V2 (O) cystoscopes had a total range of deflection of 341 degrees and 281 degrees, respectively. Total range of deflection with the KS cystoscope was reduced to 275 degrees, 250 degrees, and 311 degrees for the Coloplast NBI070, Laborie DIS200, and Olympus NM-101C-0427 needles, respectively. Total range of deflection with the O cystoscope was reduced to 195 degrees, 157 degrees, and 257 degrees for Coloplast NBI070, Laborie DIS200, and Olympus NM-101C-0427 needles, respectively. Average flow rates with an empty working channel were 5.7 mL/s and 5.5 mL/s for the KS and O cystoscopes, respectively. Mean flow rate with the KS cystoscope was reduced to 1.0 mL/s, 0.1 mL/s, and 0.7 mL/s for Coloplast NBI070, Laborie DIS200, and Olympus NM-101C-0427 needles, respectively. Mean flow rate with the O scope was reduced to 0.5 mL/s, 0.1 mL/s, and 0.4 mL/s for Coloplast NBI070, Laborie DIS200, and Olympus NM-101C-0427 needles, respectively. Among commercially available intradetrusor BTX-A injection needles, the Olympus NM-101C-0427 allows for the greatest total range of deflection and has the greatest elasticity and flexibility. Coloplast NBI070 allows for the best flow rate.

Sun′s tip-flexible ureterorenoscope for retrograde ureteral and intrarenal surgery in vitro evaluation and in porcine model study

Objective To evaluate the efficacy and safety of the Sun′s tip-flexible ureterorenoscope (tf-URS) for retrograde ureteral and intrarenal surgery in porcine model. Methods Retrograde ureteral and intrarenal surgery was performed bilaterally in nine female yorkshire porcines with six-month old in June 2014. The average weight of the procines was (52.2±5.2)kg. In vitro evaluation of maximum deflection was firstly conducted with no working instruments, 200 μm laser fiber and 1.7F basket were inserted, and then followed the in vivo operation. The tf-URS was advanced through the ureter under visual and X-ray direction in its rigid mode. When the endoscope reached the ueteropelvic junction, the inner flexible part was extended out to perform the full inspection of the collecting system, according to the sequence of pelvis, upper calces, middle calces and lower calces. Retrograde pyelography to determine whether any calyces were missed on entry was performed. Reproducibility and stability test were also conducted to verify whether there was a decrease with a 200 μm laser fiber or a 1.7F basket insertion in the working channel. Results In vitro deflection of tf-URS were 251°/270° with empty working channel, 238°/249° with 200 μm laser fiber and 265°/249° with 1.7F basket insertion, respectively. The success rate of the endoscope introduction was 100% and the average time was (54.9±22.6)s (range 20-95 s). All physiological stricture or torsion could be easily passed. The mean inspection time was(218.3±69.4)s (range 120-378 s). Of all 177 calyes, 170 (96.0%) could be adequately entered and capacity of inspection decreased by 2.9% (5/170) with 200 μm laser fiber and 0% (0/170) with basket introduced, respectively. There was no sign of complications and endoscopic damage occurred after all there examinations. Conclusion The tf-URS is safe and effective tools for retrograde ureteral and intrarenal surgery, even with auxiliary instruments. Key words: Retrograde intrarenal surgery; Rigid ureteroscope; Flexible ureteroscope; Renal stone

PD37-07 IN VIVO AND EX VIVO COMPARISON OF OPTICS AND PERFORMANCE OF A NOVEL DUAL CHANNEL FIBEROPTIC URETEROSCOPE

You have accessJournal of UrologyStone Disease: New Technology II1 Apr 2014PD37-07 IN VIVO AND EX VIVO COMPARISON OF OPTICS AND PERFORMANCE OF A NOVEL DUAL CHANNEL FIBEROPTIC URETEROSCOPE Achim Lusch, Zhamshid Okhunov, Ramtin Khanipour, Ashleigh Menhadji, Renai Yoon, Michael Del Junco, and Jaime Landman Achim LuschAchim Lusch More articles by this author , Zhamshid OkhunovZhamshid Okhunov More articles by this author , Ramtin KhanipourRamtin Khanipour More articles by this author , Ashleigh MenhadjiAshleigh Menhadji More articles by this author , Renai YoonRenai Yoon More articles by this author , Michael Del JuncoMichael Del Junco More articles by this author , and Jaime LandmanJaime Landman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2025AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Vision during ureteroscopic laser ablations of large kidney stones can be challenging due to the diminished flow during the procedure. Hence we evaluated and compared characteristics of a novel dual working channel fiberoptic ureteroscope [Cobra (Richard Wolf, Knittlingen, Germany)] to two single channel fiberoptic ureteroscopes and a single channel distal sensor ureteroscope [the Viper (Richard Wolf, Knittlingen, Germany)], the X2 (Karl Storz, Tuttlingen, Germany) and the URF-V (Olympus America Inc., Center Valley, USA)]. METHODS The four ureteroscopes (Cobra, Viper, X2, URF-V) were compared for active deflection, irrigation flow and optical characteristics. Each ureteroscope was evaluated with an empty working channel and with various accessories. We performed a porcine ureteroscopy and measured the time for cleaning the middle calyx after injection of 10 cc’s of an standardized bloody solution (simulated bloody vision). RESULTS The URF-V showed a higher resolution [7.42 lines/mm] [p=0.0001] compared to the fiberoptic ureteroscopes. Among the fiberoptic ureteroscopes the Cobra had the highest resolution compared to Viper and X2 [4,86 vs. 4.33 vs. 3.56 lines/mm, <p=0.0001]. The Cobra also showed a significant superior illumination at all distances [p<0.0001]. Grayscale distribution and color representation was identical for the fiberoptic ureteroscopes, whereas the URF-V provided superior color representation and a significant higher depth of field. The dual channel ureteroscope provided superior flow with empty working channel [86cc/min vs. 68cc/min [Viper] vs. 62,5cc/min [X2] vs. 62cc/min [URF-V], p=0.0001] and with various accessories in the working channel [p<0.0001]. With regards to deflection the Storz X2 and the Cobra provided superior deflection up and down with empty working channel and several accessories [p<0.0001], except for downward deflection with a guide wire and 3.2 F delta wire grasper, where the URF-V showed superior results. When evacuating a standardized bloody field, the Cobra provided significant shorter evacuation times compared to Viper, X2 and URF-V [36.6 sec. vs. 72 sec. vs. 65.6 sec. vs. 72.6 sec, p=0.0001]. CONCLUSIONS In this in vitro porcine evaluation the dual channel ureteroscope demonstrated superior flow without and with various accessories. The additional working channel may improve vision and performance during challenging ureteroscopic cases by providing an increased flow. The enhanced irrigation capabilities of the Cobra have to be balanced with a larger diameter of this ureteroscope. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e948 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Achim Lusch More articles by this author Zhamshid Okhunov More articles by this author Ramtin Khanipour More articles by this author Ashleigh Menhadji More articles by this author Renai Yoon More articles by this author Michael Del Junco More articles by this author Jaime Landman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Abstracts from the 28th Annual Meeting of the Engineering and Urology SocietyMay 4, 2013San Diego, CA

Abstracts from the 28th Annual Meeting of the Engineering and Urology SocietyMay 4, 2013San Diego, CA

Comparison of Optics and Performance of a Distal Sensor High Definition Cystoscope, a Distal Sensor Standard Definition Cystoscope, and a Fiberoptic Cystoscope

To evaluate performance characteristics and optics of a new generation high-definition distal sensor (HD-DS) flexible cystoscope, a standard-definition distal sensor (SD-DS) cystoscope, and a standard fiberoptic (FO) cystoscope. Three new cystoscopes (HD-DS, SD-DS, and FO) were compared for active deflection, irrigation flow, and optical characteristics. Each cystoscope was evaluated with an empty working channel and with various accessories. Optical characteristics (resolution, grayscale imaging, color representation, depth of field, and image brightness) were measured using United States Air Force (USAF)/Edmund Optics test targets and illumination meter. We digitally recorded a porcine cystoscopy in both clear and blood fields, with subsequent video analysis by 8 surgeons via questionnaire. The HD-DS had a higher resolution than the SD-DS and the FO at both 20 mm (6.35 vs 4.00 vs 2.24 line pairs/mm) and 10 mm (14.3 vs 7.13 vs 4.00 line pairs/mm) evaluations, respectively (P <.001 and P <.001). Color representation and depth of field (P = .001 and P <.001) were better in the HD-DS. When compared to the FO, the HD-DS and SD-DS demonstrated superior deflection up and irrigant flow with and without accessory present in the working channel, whereas image brightness was superior in the FO (P <.001, P = .001, and P <.001, respectively). Observers deemed the HD-DS cystoscope superior in visualization in clear and bloody fields, as well as for illumination. The new HD-DS provided significantly improved visualization in a clear and a bloody field, resolution, color representation, and depth of field compared to SD-DS and FO. Clinical correlation of these findings is pending.

A New Era: Performance and Limitations of the Latest Models of Flexible Ureteroscopes

To comparatively study 3 of the latest models of flexible ureteroscopes using both subjective and objective parameters. Three models of flexible ureteroscopes (Karl Storz Flex-Xc, Olympus URF-Vo, and Wolf Cobra) were evaluated during 90 procedures. For each model, 20 procedures were therapeutic for pyelocaliceal lithiasis and 10 were diagnostic. The maneuverability and visibility were scored and compared, and the irrigation flow and maximal deflection were measured in an ex vivo setting, with an empty working channel and with accessory instruments in place. Instrument durability was also reviewed. All models demonstrated good maneuverability, with a slight advantage for the Flex-Xc. During the diagnostic procedures, failure to access the entire pyelocaliceal system occurred in 2 cases with the URF-Vo, both because of a thin caliceal infundibulum, and in 1 case with the Cobra, because of complex caliceal architecture. Regarding visibility, although the performance of the digital models was relatively similar, the fiberoptic Cobra achieved a lower score. Loss of deflection and irrigation when using the various ancillary instruments was similar for all 3 endoscopes, but the Cobra offered supplementary flow through a secondary channel. The mean deflection loss was 5% for the URF-Vo, 9% for the Flex-Xc, and 10% for the Cobra. The visual quality of the 2 digital models remained unchanged during the study; however, in the fiberoptic ureteroscope, 58 optic fibers were broken. The latest models of flexible ureteroscopes have proved to be effective instruments for upper urinary tract endoscopic interventions. There is still room for improvement, already made possible by the technological advances.

In Vitro and In Vivo Comparison of Optics and Performance of a Distal Sensor Ureteroscope Versus a Standard Fiberoptic Ureteroscope

Recent advances in distal sensor technologies have made distal sensor ureteroscopes both commercially and technically feasible. We evaluated performance characteristics and optics of a new generation distal sensor Flex-X(C) (X(C)) and a standard flexible fiberoptic ureteroscope Flex-X(2) (X(2)), both from Karl Storz, Tuttlingen, Germany. The ureteroscopes were compared for active deflection, irrigation flow, and optical characteristics. Each ureteroscope was evaluated with an empty working channel and with various accessories. Optical characteristics (resolution, grayscale imaging, and color representation) were measured using United States Air Force test targets. We digitally recorded a renal porcine ureteroscopy and laser ablation of a stone with the X(2) and with the X(C). Edited footage of the recorded procedure was shown to different expert surgeons (n=8) on a high-definition monitor for evaluation by questionnaire for image quality and performance. The X(C) had a higher resolution than the X(2) at 20 and 10 mm 3.17 lines/mm vs 1.41 lines/mm, 10.1 vs 3.56, respectively (P=0.003, P=0.002). Color representation was better in the X(C). There was no difference in contrast quality between the two ureteroscopes. For each individual ureteroscope, the upward deflection was greater than the downward deflection both with and without accessories. When compared with the X(2), the X(C) manifested superior deflection and flow (P<0.0005, P<0.05) with and without accessory present in the working channel. Observers deemed the distal sensor ureteroscope superior in visualization in clear and bloody fields, as well as for illumination (P=0.0005, P=0.002, P=0.0125). In this in vitro and porcine evaluation, the distal sensor ureteroscope provided significantly improved resolution, color representation, and visualization in the upper urinary tract compared with a standard fiberoptic ureteroscope. The overall deflection was also better in the X(C), and deflection as well as flow rate was less impaired by the various accessories.

1549 IN VITRO AND IN VIVO COMPARISON OF OPTICS AND PERFORMANCE OF A DISTAL SENSOR URETEROSCOPE (STORZ FLEX-XC) VS. A STANDARD FIBEROPTIC URETEROSCOPE (STORZ FLEX-X2)

You have accessJournal of UrologyStone Disease: New Technology1 Apr 20131549 IN VITRO AND IN VIVO COMPARISON OF OPTICS AND PERFORMANCE OF A DISTAL SENSOR URETEROSCOPE (STORZ FLEX-XC) VS. A STANDARD FIBEROPTIC URETEROSCOPE (STORZ FLEX-X2) Achim Lusch, Zhamshid Okhunov, Alberto Perez Lanzac, Reza Alipanah, Samuel Juncal, and Jaime Landman Achim LuschAchim Lusch Orange, CA More articles by this author , Zhamshid OkhunovZhamshid Okhunov Orange, CA More articles by this author , Alberto Perez LanzacAlberto Perez Lanzac Orange, CA More articles by this author , Reza AlipanahReza Alipanah Orange, CA More articles by this author , Samuel JuncalSamuel Juncal Orange, CA More articles by this author , and Jaime LandmanJaime Landman Orange, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3059AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent advances in distal sensor technologies have made distal sensor ureteroscopes both commercially and technically feasible. We evaluated the performance characteristics and optics of a new generation distal sensor (Flex-XC, Karl Storz, Tuttlingen, Germany)(Xc) and a standard flexible fiberoptic ureteroscope (Flex-X2, Karl Storz, Tuttlingen, Germany)(X2). METHODS The two ureteroscopes were compared for active deflection, irrigation flow rates and optical characteristics. Each ureteroscope was evaluated with an empty working channel and with various standard accessories. Optical characteristics (resolution, grayscale imaging and color representation) were measured using USAF optical test targets. The ureteroscopes were tested in vivo in a porcine model using a HD monitor and an HD recording system. We digitally recorded a renal porcine ureteroscopy and laser ablation of a stone with the X2 and with the XC. Edited footage of the recorded procedure was shown to expert surgeons (n=8) on a HD monitor for evaluation by questionnaire for image quality and performance. RESULTS The XC had a higher resolution than the X2 at 20 and 10 mm 3.17 lines/mm vs. 1.41 lines/mm, 10.1 vs 3.56, respectively (p=0.003,p=0.002). Color representation was better in the XC. There was no difference in contrast quality between the two ureteroscopes. For each individual ureteroscope, the upward deflection was greater than the downward deflection both with and without accessories. When compared to the X2, the XC manifested superior deflection and irrigant flow (p<0.0005, p<0.05) with and without accessory present in the working channel. When an accessory was present in the working channel, the X2 demonstrated less diminishment of deflection compared to empty working channel deflection than the XC (p<0.0005 for combined up and down deflection). Observers deemed the distal sensor ureteroscope superior in visualization in clear and bloody fields, as well as for illumination. (p=0.0005, p=0.002, p=0.0125). CONCLUSIONS In this in vitro and porcine evaluation the distal sensor ureteroscope appears to provide significantly improved resolution and color representation as compared to a standard fiberoptic ureteroscope. The overall deflection was also better in the XC and deflection as well as flow rate was less impaired by the various accessories. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e635 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Achim Lusch Orange, CA More articles by this author Zhamshid Okhunov Orange, CA More articles by this author Alberto Perez Lanzac Orange, CA More articles by this author Reza Alipanah Orange, CA More articles by this author Samuel Juncal Orange, CA More articles by this author Jaime Landman Orange, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Flow matters: irrigation flow differs in flexible ureteroscopes of the newest generation

The development of new-generation flexible ureteroscopes has improved diagnostic and therapeutic endourological procedures. Despite technical improvement irrigation flow and quality of vision is often unsatisfactory. This study describes inter-manufactural differences in the latest available flexible ureteroscopes in terms of irrigation flow in correlation to different deflection angles and the use of 1.9 Fr. stone baskets. Irrigation flow measurements were performed in five new-generation flexible ureterorenoscopes with 3.6 Fr. working channels: Wolf (Uretero-Renoscope 270°), Storz (Flex-X² and Flex-X(c)), ACMI (DUR-D) and Olympus (URF Type P5) in 0°, 90° and 180° deflection. All measurements were carried out five times with an empty working channel as well as with inserted 1.9 Fr. stone baskets. Mean flow rates with empty instruments (SD) counted 50ml/min (0.8), 50 (1.0), 48 (1.7), 48 (1.6) and 44 (0.7) for ACMI, Wolf, Storz (FlexX² and Flex-X(c)), and Olympus, respectively. Stone baskets significantly reduced irrigation flows in all tested ureteroscopes (p<0.05). In channels with inserted baskets, the highest flow rates were measured for ACMI and Wolf with 12ml/min (0.7) each. The lowest reduction of flow rate was detected in the ACMI and the Wolf ureteroscope (76.0%, 38ml/min each). Measurements after flexion showed no significant differences between the ureteroscopes. Latest generation of flexible ureteroscopes offer various new product developments, including excellent deflection capacities. This study showed inter-manufactural differences in terms of irrigation flow rates with either empty or occupied working channels resulting in significant alterations in endoscopic view.

1391 THE IMPACT OF DIFFERENT UPPER URINARY TRACT BIOPSY DEVICES ON THE PERFORMANCE OF FLEXIBLE URETERORENOSCOPES: STANDARDIZED EX VIVO COMPARISON

You have accessJournal of UrologyTechnology & Instruments: Ureteroscopy1 Apr 20111391 THE IMPACT OF DIFFERENT UPPER URINARY TRACT BIOPSY DEVICES ON THE PERFORMANCE OF FLEXIBLE URETERORENOSCOPES: STANDARDIZED EX VIVO COMPARISON Christian Bolenz, Manuel Ritter, Thorsten Bach, Maurice Stephan Michel, and Axel Häcker Christian BolenzChristian Bolenz Mannheim, Germany More articles by this author , Manuel RitterManuel Ritter Mannheim, Germany More articles by this author , Thorsten BachThorsten Bach Hamburg, Germany More articles by this author , Maurice Stephan MichelMaurice Stephan Michel Mannheim, Germany More articles by this author , and Axel HäckerAxel Häcker Mannheim, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1238AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Diagnostic and staging errors are common problems in the management of upper tract urothelial lesions. Biopsy forcipes for flexible ureterorenoscopes have been developed to improve diagnostic accuracy. Newly developed biopsy devices allow for acquisition of larger tissue samples but may complicate the handling of ureterorenoscopes. We evaluated the influence of 5 different biopsy forcipes on the deflection, irrigant flow and optical characteristics of 3 different flexible ureterorenoscopes. METHODS Five different biopsy forcipes were compared: Olympus (FB-56D-1;diameter 5Fr.), R. Wolf (829.601;3Fr.), Karl Storz Medical (11275ZE;3Fr.), Boston Scientific (Piranha; 505–160;3 Fr.) and the backloading Cook BIGopsy (115CM;2.4 Fr.) device. The devices were tested in 3 different ureterorenoscopes: Storz 11278VU (Flex-X2), Storz 11278V (Flex-XC) and Wolf Cobra (7326071/-6). Active deflection (angle), irrigation flow rates (ml/min) and optical characteristics (field of view) were evaluated, each with an empty working channel and with inserted biopsy device. RESULTS Baseline irrigation flow rates were significantly higher in the Wolf Cobra than in Storz ureterorenoscopes (30.5 vs. 23 and 21 ml/min). The separate working channel of the Wolf Cobra provided unchanged flow rates with inserted biopsy forceps. A significant reduction of irrigation flow was observed in Storz Flex-X2 (maximum 1.3 ml/min) and Storz Flex-XC (2.2 ml/min) with any forceps inserted. No differences in irrigation flow rates were found with introduced biopsy device when the scopes were deflected or straight. The BIGopsy forceps provided higher flow rates in both Storz scopes (2.2 and 1.3, respectively) when compared to the other devices (0.5 and 0.6 ml/min). The Storz and Wolf biopsy forcipes resulted in the highest impairment of deflection angle (minus 95, 123 and 114 degrees, respectively). In all 3 ureterorenoscopes flow rates and angle of deflection were least impaired by BIGopsy. Insertion of the BIGopsy device in any ureterorenoscope reduced the field of view by at least 20% compared to a maximum of 12% reduction caused by the other forcipes. CONCLUSIONS The various biopsy devices differ in the impairment of irrigation flow rates, degree of deflection and reduction of field of view. The Cook BIGopsy forceps allows for the least impairment of irrigation flow in single-channel flexible ureterorenoscopes due to a smaller diameter and does not significantly impair deflection. However, a smaller field of view may hamper tissue acquisition. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e555-e556 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Bolenz Mannheim, Germany More articles by this author Manuel Ritter Mannheim, Germany More articles by this author Thorsten Bach Hamburg, Germany More articles by this author Maurice Stephan Michel Mannheim, Germany More articles by this author Axel Häcker Mannheim, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Irrigant Flow and Intrarenal Pressure During Flexible Ureteroscopy: The Effect of Different Access Sheaths, Working Channel Instruments, and Hydrostatic Pressure

Our aim was to determine the optimal size of access sheath for ureteroscopy and stone lasertripsy to achieve good irrigant flow while maintaining the lowest possible intrarenal pressure. We used an in vitro anatomic model into which a pressure transducer was incorporated. Cook Peel-Away 10F, Flexor 12F, 14F, 16F single lumen, and a new 14F Flexor dual-lumen sheath were tested. Irrigant flow and intrarenal pressure were measured with an empty ureteroscope working channel and with a 1.4F or 2.4F basket within the working channel with a hydrostatic pressure of 1 m and 2 m, respectively. For the dual-lumen sheath, the irrigation was either connected to the scope or the second channel of the access sheath. Two other configurations were tested: 4F ureteral catheter placed alongside a 10F sheath (configuration 1) or a 5F ureteral catheter within a 16F access sheath (configuration 2). With an empty working channel, irrigant flow increased with sheath diameter. The presence of a 1.4F or 2.4F basket, however, reduced flow up to 65% and 90%, respectively. Increasing the hydrostatic column to 2 m height improved the irrigant flow but with a predisposition to a higher intrarenal pressure. Using configurations 1 and 2, the flow rates improved by 250% and 700%, respectively, with a 2.4F basket in the working channel, and could also be used with a 2 m hydrostatic column without raising the intrarenal pressure. Increased access sheath diameter does not improve flow when the working channel of a flexible ureteroscope is occupied. Our proposed configuration of a ureteral access catheter placed inside or alongside the access sheath provides by far the highest flow rates without a rise in the intrarenal pressure.

The PolyScope: A Modular Design, Semidisposable Flexible Ureterorenoscope System

To characterize the mechanical and optical properties of the PolyScope endoscope system and to examine the clinical outcome in patients who were undergoing ureteronephroscopy. Mechanical assessment involved measurement of the deflection angle and irrigation flow rate. Optical resolution and distortion, field and angle of view, and light transmission and output formed the optical assessment. Clinical assessment was made in a series of consecutive ureteronephroscopy procedures. The optical cord was disconnected after each procedure, and the image fiber was assessed for damage. The mean value for the angle of maximum active tip deflection with an empty working channel was 265 degrees (261-275 degrees). Deflection was impaired most with insertion of the 3.0 F basket (10% decrease) and least with an indwelling 220 microm laser fiber (2% decrease). Irrigation flow rate was 57 mL/min with an empty working channel. Flow was reduced by 50% and 68%, with the insertion of a 200 microm or 365 microm laser probe, respectively, and by 92.5% with a 3.2F basket. No damage to the image fiber occurred. The PolyScope optics system could identify a target of about 0.125 mm at a distance of 2 to 4 mm, based on 3 line-pairs/mm needed for clear identification. Lithotripsy of renal calculi was performed for 40 stone burdens in 32 patients; the resulting stone-free rate was 87.5%. The novel semidisposable ureteroscope system PolyScope was simple to use, effective, and reliable in this preliminary clinical evaluation. It overcomes the inherent fragility of comparable devices, which renders the need for maintenance unnecessary.

Conventional Fiberoptic Flexible Ureteroscope Versus Fourth Generation Digital Flexible Ureteroscope: A Critical Comparison

Development of flexible renoureteroscopy had a significant impact on the diagnosis and management of upper urinary tract pathology. The aim of our study was to compare the performances of a fiberoptic flexible ureteroscope (FFU) with those of a digital flexible ureteroscope (DFU). We compared the maneuverability, visibility, and fragility of a Storz 11274AA FFU and of an Olympus URF-Vo DFU. In 44 diagnostic retrograde procedures (22 with FFU and 22 with DFU), the maneuverability and visibility were evaluated with a score ranging from 1 to 5. The success of the inferior calix approach, maximal deflection, irrigation flow, and the endoscopes' fatigability were also compared. FFU and DFU received mean scores of 3.64 vs 4.27 for maneuverability and 3.27 vs 4.68 for visibility. In four cases, acute infundibulopelvic angle and long infundibulum prevented the inferior calix approach with FFU. In two cases, the approach of the narrow infundibulum was impossible using DFU. The normal/pressure irrigation flow through FFU and DFU was 54/144 vs 60/150 mL/min with an empty working channel, decreasing to almost 0 mL/min with 3F instruments inserted. The maximal deflection loss of FFU and DFU ranged between 8% to 50.6% vs 0% to 21.1%, depending on the accessory instrument inserted through the working channel. After 22 procedures, the deflection loss was 10 degrees for the FFU and 0 degrees for the DFU. DFU proved to have superior maneuverability and visibility, which may translate into improved performances. The larger tip of the DFU may decrease its accessibility, especially in narrow segments of the upper urinary tract.