Reusable Flexible Ureteroscopes Research Articles

The cost-effectiveness of reusable flexible ureteroscopes: An institutional audit.

A flexible ureteroscope (FU) is an important tool in the urologist's armamentarium. This study aims to check the durability and cost-effectiveness of conventional FU. The institution registry of damaged FU over the last 7 years was reviewed. A total of 17 flexible scopes were used. The data of 13 scopes (11 Storz fiberoptic and 2 Seesheen digital) are included in this study. A total of 1905 cases were performed. The cost of scope, duration of use, number of cases done by each scope, and nature of damage were evaluated. We compared the cost-effectiveness of conventional scopes with published costs on disposable scopes. The mean number of cases done by fiberoptic scope was 159 (range 25-334). The total cases done by 2 digital scopes were 135 and 25. The mean life of fiberoptic and digital scopes was 17 (range 4-31) and 8 months, respectively. The mean cost of fiberoptic scope was Indian Rupee (INR) 338,951 ($4082.7221) and INR 525,000 ($6323.7138) for digital scope. The cost per case for reusable scope is calculated by dividing the mean cost of FU by the mean number of cases done. The reprocessing cost of INR 527 was then added. Thus, the average cost per procedure for fiberoptic and digital FU was INR 2658.76 and INR 7089.50, respectively. We compared this cost with a projected cost of disposable FUbased on today's market data, which ranged from INR 60,000 to 107,427. The reusable scopes are durable, cost-effective, and an excellent option for high case-load institutions.

The Effect of Reusable Flexible Ureteroscope Aging on the Efficacy and Safety of Retrograde Intrarenal Surgery.

Purpose: Reusable flexible ureteroscopes may lose their mechanical functionality through overuse, which is known as "aging of the flexible ureteroscope." Although mechanical deterioration has been shown in several studies, the data about the effect of this situation on the efficacy and safety of retrograde intrarenal surgery (RIRS) are missing. The aim of our study was to evaluate the effect of the aging of flexible ureteroscopes on the efficacy and safety of RIRS. Methods: Patients who had undergone RIRS between 2017 and 2021 at a single center were retrospectively included in the study. Serial surgeries were performed using the same reusable flexible ureteroscope (Storz X2) until it was broken or malfunctioned because of the aging process. Group 1 was formed by the first 10 cases on whom the flexible ureteroscopes were used, representing the youngest period of the instruments, whereas group 2 was composed of the last 10 cases on whom the flexible ureteroscopes were used, representing the oldest phase of the instruments. The operative and postoperative data-including the operation time, hospitalization time, intraoperative complications, postoperative complications, and stone-free rates-were compared between the two groups. Results: A total of five flexible ureteroscopes were included in the study. The number of cases for each flexible ureteroscope ranged between 87 and 133, with a median number of 107 cases. The demographic and clinical properties of patients in both groups were similar. The operation time, lasering time, and total laser pulse were similar between the groups. The stone-free rates in group 1 and group 2 were 82.0% and 78.0%, respectively (p = 0.304). The complication rates were also similar between the groups (p = 0.591). Conclusion: The aging of reusable flexible ureteroscopes did not negatively affect the efficacy and safety of RIRS. Therefore, surgeons may use the reusable types of flexible ureteroscopes until they are totally broken.

In vitro Comparison of the Mechanical and Optical Characteristics of 5 Disposable Flexible Ureteroscopes

Introduction: Disposable (single-use) flexible ureteroscopes are alternatives to reusable ureteroscopes. With their superior surgical efficacy and safety in the presence of upper urinary calculi, disposable ureteroscopes aim to overcome the main limitations of conventional reusable ureteroscopes. However, studies on the performance of the most recently developed models of single-use flexible ureteroscopes are scarce. This study aimed to compare the in vitro performance of several recently introduced, single-use, flexible ureteroscopes. Methods: Five disposable flexible ureteroscopes were tested in vitro to evaluate their mechanical and optical characteristics. To this end, their degrees of deflection, irrigation flow rates, and image qualities were investigated. The models examined were Innovex US31-B12, OTU-100RR, Redpine RP-U-C12, Sciavita SUV-2A-B, and Seplou URS3016E. Their performance was also compared with that of a reusable flexible ureteroscope, Olympus URV-F. Results: The OTU device had the highest degrees of deflection and the smallest loop diameter of the disposable ureteroscopes. The single-use ureteroscopes had identical image resolutions at a distance of 1 cm. The Innovex and Redpine devices had the best color representation. Conclusions: Of the tested disposable ureteroscopes, the OTU device had the best mechanical attributes, given its small loop diameter, high deflection angles, and low irrigation flow loss. As to their optical properties, the resolutions of all 5 single-use models were identical at an image distance of 1 cm.

Comparing outcomes of single-use vs reusable ureteroscopes: a systematic review and meta analysis.

Flexible ureterolithotripsy is a frequent urological procedure, usually used to remove stones from the kidney and upper ureter. Reusable uretero-scopes were the standard tool for that procedure, but recent concerns related to sterility and maintenance and repair costs created the opportunity to develop new technologies. In 2016, the first single-use digital flexible ureteroscope was introduced. Since then, other single-use ureteroscopes were developed, and studies compared them with the reusable ureteroscopes with conflicting results. The purpose of this study is to describe the literature that compares the performance of single-use and reusable flexible ureteroscopes in retrograde intrarenal surgery for urinary stones. A Systematic Review was performed in October 2022 in accordance with the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA). A search in MEDLINE, EMBASE, Web of Science, Google Scholar and LILACS retrieved 10,039 articles. After screening, 12 articles were selected for the Meta-Analysis. No differences were found in stone-free rate (OR 1.31, CI 95% [0.88, 1.97]), operative time (MD 0.12, CI 95% [-5.52, 5.76]), incidence of post-operative fever (OR 0.64, CI 95% [0.22, 1.89]), or incidence of post-operative urinary tract infection (OR 0.63 CI 95% [0.30, 1.32]). No differences were observed in the studied variables. Hence, the device choice should rely on the availability, cost analysis and surgeons' preference.

Single-use flexible ureteroscopes: practice patterns, attitudes, and preferences for next-generation concepts.

Single use flexible ureteroscopes (su-fURS) have emerged as an alternative to reusable flexible ureteroscopes (r-fURS) for the management of upper urinary tract calculi. However, little is known about urologist usage and attitudes about this technology. Through a worldwide survey of endourologists, we assessed practice patterns and preferences for su-fURS. An online questionnaire was sent to Endourology Society members in January 2021. The survey explored current su-fURS practice patterns, reasons for/against adoption, and preferences for next generation models including developments in imaging, intra-renal pressure, heat generation, and suction. Responses were collected through QualtricsXM over a 1-month period from surgeons in North America, Latin America, Europe, Asia, Africa, and Oceania. The study was conducted according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). 208 (13.9%) members responded to the survey. Most respondents (53.8%) performed >100 ureteroscopies per year. 77.9% of all respondents used su-fURS for less than half of all procedures while only 2.4% used su-fURS for every procedure. 26.0% had never used a su-fURS. Overall, usage was not influenced by a surgeon's geographic region, practice environment, or years of experience. Top reasons for not adopting su-fURS were cost (59.1%) and environmental impact (12.5%). The most desired improvements in design were smaller outer shaft size (19.4%), improved optics and vision (15.9%), and wireless connectivity (13.6%). For next generation concepts, the functions most commonly described as essential or important by respondents was the ability to suction fragments (94.3%) while the function most commonly noted as not important or unnecessary was incorporation of a temperature sensor (40.4%). su-fURS are not commonly used, even among urologists who perform a high number of fURS. The primary concern for adoption is cost and environmental impact. Suction capability was considered the most important future development.

Single-use flexible ureteroscope provides an alternative treatment for upper urinary calculi: A systematic review and meta-analysis.

This study aimed to evaluate the efficacy and safety of single-use flexible ureteroscope and reusable flexible ureteroscope for upper urinary calculi. We conducted a meta-analysis that had a comprehensive search in PubMed, Embase, Cochrane Library, Web of Science, and WanFang databases from 2000/01/01 to 2023/06/01 for available randomized controlled trials. "Ureteroscopes," "Flexible Ureteroscope," "Single-use," and "Upper Urinary Calculi" were used as the major keywords for the search. Review Manager 5.0 and STATA 12.0 were used for calculation and statistical analysis. A total of 9 randomized controlled trials comprising 1293 participants were included in our meta-analysis. Single use-FURS had better results in stone-free rate (relative risk: 1.08, 95% confidence interval: [1.02, 1.15], P = .02) and postoperative infection (relative risk: 0.41, 95% confidence interval: [0.23, 0.72], P = .002). Operative time, hemoglobin decline, postoperative serum creatinine, postoperative hospital stay, and overall complication after surgery showed no significant differences between the 2 procedures (P > .05). Single-use flexible ureteroscope provides a valuable alternative to reusable flexible ureteroscope in upper urinary calculi with its better visual field performance and manipulation, opening a new technological revolution for kidney stone treatment.

LithoVue Elite Compared With Single-Use and Reusable Ureteroscopes: A Bench and Human Cadaver Study

Purpose: To compare the attributes of the next-generation LithoVue Elite (LVE, Boston Scientific Corporation) with current state-of-the-art single-use and reusable flexible ureteroscopes. Methods: LithoVue Elite is the latest single-use flexible ureteroscope with improved functionality and a novel ability to measure intrarenal pressure. In this study, we compare LVE with 3 single-use ureteroscopes (Pusen, WiScope, and Anqing) and 1 reusable ureteroscope (Olympus). A bench model was used to measure the physical characteristics (tip deflection and irrigation) and image quality (resolution, color accuracy, field of view, and latency). A human cadaveric model was used to score the maneuverability and ergonomics. This abstract shows the least square means from multiway ANOVAs used for analysis. Results: The ureteroscopes showed a tip deflection ranging from 243° to 306° with LVE at 279°. The irrigation rates ranged from 28 to 44 mL/min with LVE at 40 ml/min. LVE had a resolution of 6.34 line pair/mm, while the other scopes ranged from 4.86 to 5.77 line pairs/mm. The color accuracy was quantified with Delta E, an image analysis variable, which ranged from 14 to 42 with LVE at 28. The field of view ranged from 55° to 89°, and LVE was at 89°. The image latency ranged from 41 to 92 ms with LVE at 58 ms. Finally, the maneuverability scores ranged from 3.8 to 4.1 of 5 with LVE scoring 4.1 while the ergonomics scores ranged from 2.4 to 4.8 with LVE scoring 4.4. Conclusion: LithoVue Elite had above average performance compared with single-use and reusable ureteroscopes and upper-range scores for resolution, field of view, maneuverability, and ergonomics. Accordingly, LVE shows promise; however, further research is needed to assess the impact of intrarenal pressure on the standard of care.

EDITORIAL COMMENT Re: Device Failure and Adverse Events Related to Single-use and Reusable Flexible Ureteroscopes: Findings and New Insights From an 11-Year Analysis of the Manufacturer and User Facility Device Experience Database. Urology. 2023 Jul;177:41-47

We are accustomed to embracing new technology with a bit of hype, and reviewing its pro's while in trend. However, innovations that don't stand the test of time tend to disappear into thin air, leaving no trace of the details leading to their ill fate. Pat Jones et al. have touched the much anticipated area of timely health technology assessment, reflecting on newly available single-use flexible ureteroscopy (fURS) equipment, by accessing post-marketing data from a crowd-sourced database. Accessed March 20, 2023. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm

Device Failure and Adverse Events Related to Single-use and Reusable Flexible Ureteroscopes: Findings and New Insights From an 11-Year Analysis of the Manufacturer and User Facility Device Experience Database

To catalog and characterize device failures and adverse events related to flexible ureteroscopes from a national database. Search of the Manufacturer User and Facility Device Experience database was performed for all recorded events related to flexible ureteroscopes between 2012 and 2022. The following information was collected: Problem and cause, timing, complications and injury, prolonged anesthesia, and early termination of procedure. Event severity was graded using a validated tool. A total of 206 events were identified (reusable/single use ratio, 2.5:1). There were 20 different problem categories reported, which included image loss (26.7%), difficulty removing scope (13.6%), scope damage from basket (4.4%), detachment of scope tip (5.8%) and contamination (4.9%). Faulty device was the predominant cause for an event related to single-use scopes (86.4%); this was seldom the case for reusable (2%). Patient injury occurred in 21.8%, but these were all in reusable scopes. No deaths were reported, but major complications included complete avulsion of the ureter (3.4%) and fully entrapped scope necessitating open surgery (2.9%). While the safety profile for single-use scopes was superior, they were significantly more likely to result in early termination (71.1% vs37.3%, P < .001). This was related to 76.3% of the single-usescopes experiencing sudden image loss. Flexible ureteroscopes are fragile, and a multitude of problems can occur. Many of these can be avoided through correct surgeon technique and robust maintenance services.

Single-Use Ureteroscopy and Environmental Footprint: Review of Current Evidence.

Ureteroscopy is a well-established treatment modality for kidney and ureteric calculi in addition to playing a key role in upper tract cancer diagnostics. Traditional reusable flexible ureteroscopes are technologically advanced and expensive pieces of equipment that require repeat sterilisation and periodical repair. These issues have led to the development of single-use flexible ureteroscopes that are disposed of after each case. Whilst this may be advantageous in many respects, the environmental impact of such technology is yet to be fully determined. The aim of this review is to therefore identify and summarise the available literature concerning the environmental footprint of single-use ureteroscopy. To identify the latest research on this topic, a systematic search of world literature was conducted using the Medline, Embase, and PsycINFO databases. PRISMA guidelines were followed and articles were assessed by all authors and relevant study results were included in a narrative format. Only one relevant article was identified and included. This study found that a single-use flexible ureteroscope (LithoVueTM by Boston Scientific) generated an equivalent amount of carbon dioxide per case to a contemporary reusable flexible ureteroscope. Literature concerning the environmental footprint of single-use ureteroscopy is worryingly lacking. No conclusions can be definitively drawn from a single study and further research is imperative given the global climate crisis and the significant contribution that healthcare services have to the environmental problem.

Comparison of Flexible Ureteroscope Performance between Reusable and Single-Use Models.

Single-use flexible ureteroscopes for urinary retention have been developed in recent years as an alternative to reusable ureteroscopes in order to eliminate the risk of cross-infections and to solve the primary limitations of traditional reusable flexible ureteroscopes for urinary retention. In this study, we evaluated and contrasted three of the most recent types of flexible ureteroscopes, including two digital reusable versions (Olympus URF-V and Olympus URF-V2) and one single-use model (Pusen Medi-calUscope UE3022), in both ex vivo and in vivo scenarios. The influence of a variety of instruments on the flow of irrigation and its deflection was investigated ex vivo. In the in vivo investigation, a total of 40 patients were treated with retrograde fURS utilizing URF-V, 20 patients were treated with URF-V2, and 20 patients were treated with single-use fURS. The visibility and maneuverability of each fURS were evaluated by the same urologist during the procedures, and the results were compared. Intraoperatively, we compared the image quality of reusable (URF-V and URF-V2) and single-use fURS USCOPE UE3022 cameras and found that there was no statistically significant difference between the two types of camera. The score for maneuverability was the same (4.2) regardless of whether we used the UscopeUE3022 or the URF-V2, but it was significantly lower (3.8, p = 0.03) when we utilized the URF-V. Irrigation was about the same when utilizing reused scopes, whereas employing a single-use scope was more than fifty percent more effective. The findings of our research indicate that reusable and single-use fURs have visibility and maneuverability characteristics that are at least comparable to one another. The possibilities of the single-use type in terms of irrigation flow and deflection are superior.

Comparison of single-use flexible ureteroscopes with a reusable ureteroscope for the management of paediatric urolithiasis

To compare the efficacy, side effects, and cost-effectiveness between a single-use digital flexible ureteroscope and a reusable flexible ureteroscope in the treatment of paediatric renal stones. This analytic, case-control, monocentric study included all patients undergoing flexible ureterosopies for stone treatment. Between April 2016 and February 2019, a reusable (Flex-XC®, Karl Storz) flexible ureteroscope was used (control group), whereas a single-use (Uscope®, PUSEN Medical©) flexible ureteroscope was used in all procedures from March 2019 to April 2021. Clinical and procedural outcomes, operative times, complication rates, hospital stay, and costs per procedure were evaluated. Forty-three cases using a reusable flexible ureteroscope and thirty-nine using a single-use flexible ureteroscope were included in the study. Demographic patient characteristics, stone burden, location and composition, preoperative presence of a double-J stent, procedural outcomes, mean length of postoperative hospital stay, and complications (4.6% versus 5%, p=0.81) were comparable between the two groups. Median operative duration for stone removal was 93min (20-170) with reusable versus 81min (55-107) with the single-use scope (p=0.18). Scope failure occurred four times with the reusable scope and in no case with the single-use. The total cost per procedure associated with the use of single-use scopes (798 Euros) was lower than a reusable scope (1483.23 Euros). Single-use flexible ureteroscopes were created to bypass the problems incurred when reusable scopes were damaged and therefore not available for use in surgical procedures. Single-use flexible ureteroscopes are always immediately available and ready to be used, even in urgent cases, as they typically do not require maintenance or sterilization. Compared with their reusable counterparts, single-use flexible ureteroscopes have similar digital performance (270°), image quality and we found no difference in the success and complication rates. Cost analysis of a reusable flexible ureteroscope must consider the purchase price, maintenance and repair costs, and decontamination costs (including handling, detergent, bacterial culture, transportation, and storage costs). In contrast, only purchase price is included in cost analysis for single-use flexible ureteroscopes. Our study suggests that single-use flexible ureteroscopes may be associated with lower costs per procedure than their reusable counterparts. Single-use flexible ureteroscopes are an interesting alternative to their reusable counterparts, particularly in terms of material resource management. Cost analyses conducted using a low volume of cases representative of a paediatric urology division favour the use of single-use ureteroscopes.

RIRS with disposable or reusable scopes: does it make a difference? Results from the multicenter FLEXOR study.

With several single-use ureteroscopes now available, our aim was to analyze and compare data obtained globally from high-volume centers using both disposable and reusable flexible ureteroscopes and see if indeed in real-world practice either scope has a distinct advantage. Retrospective analysis was performed on the FLEXOR registry, which was created as a TOWER group (Team of Worldwide Endourological Researchers, research wing of the Endourological Society) endeavor. Patients who underwent retrograde intrarenal surgery (RIRS) for renal stones from January 2018 to August 2021 were enrolled from 20 centers globally. A total of 6663 patients whose data were available for analysis were divided into Group 1 (Reusable scopes, 4808 patients) versus Group 2 (Disposable scopes, 1855 patients). The age and gender distribution were similar in both groups. The mean stone size was 11.8 mm and 9.6 mm in Groups 2 and 1, respectively (p < 0.001). Group 2 had more patients with >2 cm stones, lower pole stones and of higher Hounsfield unit. Thulium fiber laser (TFL) was used more in Group 2 (p < 0.001). Patients in Group 2 had a slightly higher stone-free rate (SFR) (78.22%) and a lower number of residual fragments (RFs) compared with Group 1 (p < 0.001). The need for further treatments for RF and overall complications was comparable between groups. On multivariate analysis, overall complications were more likely to occur in elderly patients, larger stone size, lower pole stones, and were also more when using disposable scopes with longer operative time. RFs were significantly higher (p < 0.001) for lower pole, larger, harder, multiple stones and in elderly. Our real-world practice observations suggest that urologists choose disposable scopes for bigger, lower pole, and harder stones, and it does indeed help in improving the single-stage SFR if used correctly, with the appropriate lasers and lasing techniques in expert hands.

Comparison of Surgical Outcomes between Single-Use and Reusable Flexible Ureteroscopes for Renal Stone Management: A Systematic Review and Meta-Analysis.

Background and Objectives: Disposable flexible ureteroscopes have been widely used because of their cost-effectiveness and higher sterility potential compared with reusable flexible ureteroscopes. This study aimed to compare the surgical outcomes and complication rates in patients who undergo reusable or disposable flexible ureteroscopic stone surgeries (fURS) for urinary stone disease. Materials and Methods: A systematic review and meta-analysis were conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. This systematic review was registered with PROSPERO (CRD42022331291). Clinical trials comparing reusable and disposable fURS for stone disease were found from PubMed, EMBASE, Cochrane Library, and the Web of Science up to March 2022. Participants were patients with upper urinary tract stones; the interventions were reusable or disposable fURS. Outcomes, including stone-free rate, operation time, length of hospital stay, and complication rate, were compared for analysis. Results: Overall, 111 studies were identified, but after removing duplicate studies, 75 studies remained. Thirty-two of these studies were excluded. Of the 43 screened studies, 11 met the eligibility criteria. There was no difference in the stone-free rate (SFR) between disposable and reusable fURS (p = 0.14; OR = 1.36; 95% CI, 0.9 to 2.04). For operation time, no difference was identified between reusable and disposable fURS groups (p = 0.12; MD = −5.31; 95% CI, −12.08 to 1.46). For hospital stay, there was also no difference between the two groups (p = 0.61; MD = −0.03; 95% CI, −0.17 to 0.10). There was no significant difference in complication rate between the two groups (p = 0.85; OR = 0.95; 95% CI, 0.56 to 1.61). Conclusions: There were no differences in the SFR, operation time, length of hospital stay, and complication rate between reusable and disposable fURS. Disposable fURS may be a comparable alternative to reusable fURS.

Effects of repeated use of disposable FURS on efficiency, safety and cost analysis

In this study, we aimed to examine cost analysis and evaluate the results of retrograde intrarenal surgery (RIRS) performed with reusable and disposable flexible ureteroscope (FURS) devices in our clinic. In total, we included 96 patients who underwent RIRS surgery for kidney stones with reusable FURS (n = 49) and disposable FURS (n = 47). There were noted preoperative demographic data and stone characteristics of the patients. Also, operation time, fluoroscopy time, hospitalization time, urethral catheter removal time, return to work time, complication rates and cost per procedure were collected and analyzed. There were no significant differences between each groups in terms of demographic characteristics of retrospectively analyzed the data of 96 patients. In addition, the comparison made in terms of operative and postoperative results in both groups was similar. We determined significant difference for mean cost per case compared two groups. There were cost per case $ 293,87 in group 1 and $ 191,48 in group 2. We determined that the repeated use of disposable FURS compared in terms of cost analysis is a safe, effective and low cost method without increasing the infection frequency.

WiScope® single use digital flexible ureteroscope versus reusable flexible ureteroscope for management of renal stones: a prospective randomized study.

To compare the clinical performance and surgical outcomes of the new digital single use flexible ureteroscope (WiScope®) with a reusable digital flexible ureteroscope. Our prospective study includes patients with renal stones less than 2cm who underwent retrograde flexible ureteroscopy and laser lithotripsy. Patients were randomized into two groups: group A included patients who underwent laser lithotripsy using WiScope® Single use digital flexible ureteroscope and group B included patients who underwent laser lithotripsy using reusable flexible ureteroscope. Image quality, deflection, ease of insertion, maneuverability, and overall performance were assessed using either a visual analog or Likert scale. Operative outcomes and complications were collected and analyzed in both groups. A total of 242 patients were included in our study. There were 121 patients in the WiScope® group and 121 patients in reusable ureteroscope group. The WiScope® had higher maneuverability (9.3 ± 0.7 vs. 7.2 ± 0.8, P < 0.001) and less limb fatigue but had lower image quality when compared to reusable digital flexible ureteroscope (7.6 ± 0.9 vs. 9.2 ± 0.6, P < 0.001). There were no differences in operative time, complication rates and rates of relook ureteroscopy. The WiScope® single use flexible ureteroscope has comparable outcomes to the reusable flexible ureteroscope with regard to maneuverability, limb fatigue, and deflection. However, it has a lower image quality.

MP02-20 DECREASED RISK OF URINARY INFECTION IS ASSOCIATED WITH SINGLE USE URETEROSCOPES

You have accessJournal of UrologyCME1 May 2022MP02-20 DECREASED RISK OF URINARY INFECTION IS ASSOCIATED WITH SINGLE USE URETEROSCOPES Rei Unno, Xavier Cortez, Leslie Charondo, Kevin Chang, Nizar Hakam, Carter Chan, Heiko Yang, Gregory Hosier, Fadl Hamouche, David Bayne, Marshall Stoller, and Thomas Chi Rei UnnoRei Unno More articles by this author , Xavier CortezXavier Cortez More articles by this author , Leslie CharondoLeslie Charondo More articles by this author , Kevin ChangKevin Chang More articles by this author , Nizar HakamNizar Hakam More articles by this author , Carter ChanCarter Chan More articles by this author , Heiko YangHeiko Yang More articles by this author , Gregory HosierGregory Hosier More articles by this author , Fadl HamoucheFadl Hamouche More articles by this author , David BayneDavid Bayne More articles by this author , Marshall StollerMarshall Stoller More articles by this author , and Thomas ChiThomas Chi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002514.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although single-use ureteroscopes have been shown to be comparable with reusable ureteroscopes in terms of intraoperative maneuverability, visual image quality, as well as stone-related clinical outcomes, there are few large scale reports regarding clinical outcomes related to single-use ureteroscopes. In the current study, we aimed to understand the impact of single-use ureteroscopes on clinical outcomes for ureteroscopic stone removal and whether their use reduced postoperative urinary tract infection (UTI) risk. METHODS: This was a single-center, retrospective cohort study designed to compare single-use with reusable flexible ureteroscopes regarding peri- and postoperative outcomes between June 2012 and March 2021. The primary endpoint was postoperative UTI. The secondary endpoints were intraoperative outcomes (operative time and stone clearance), perioperative complications, hospitalization time, and re-presentation to the hospital (telephone call, ED visit, and re-admission) after URS. RESULTS: A total of 991 patients were analyzed, 500 patients in the single-use URS group (50.4%) and 491 patients in the reusable group (49.6%). On univariate analysis, patients in the single-use URS group were more often male and had lower BMI and presented with more bilateral stones than those in the reusable group. Single-use URS was associated with a lower chance of postoperative UTI (6.5% vs 11.9%, p=0.018) as well as a higher stone clearance rate (90.0% vs 83.9%, p=0.005) and fewer postoperative telephone calls (19.2% vs 29.2%, p=0.002). There were no significant differences in operative time, perioperative complications, ED visits, and re-admission between the two groups. On multivariate analysis, single-use URS remained a strong factor associated with stone clearance rate and decreased risk of postoperative UTI and postoperative telephone calls (Table 1). Postoperative sepsis, perioperative complications, and re-admission were associated with a positive preoperative urine culture. CONCLUSIONS: These data show that the single-use URS is beneficial in reducing postoperative UTI and telephone calls as well as increasing the stone clearance rate. These results provide a clinical justification for their routine use during ureteroscopic stone removal. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e18 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rei Unno More articles by this author Xavier Cortez More articles by this author Leslie Charondo More articles by this author Kevin Chang More articles by this author Nizar Hakam More articles by this author Carter Chan More articles by this author Heiko Yang More articles by this author Gregory Hosier More articles by this author Fadl Hamouche More articles by this author David Bayne More articles by this author Marshall Stoller More articles by this author Thomas Chi More articles by this author Expand All Advertisement PDF DownloadLoading ...

Single-use versus reusable flexible ureteroscope: Technical and medico-economic aspects

Sate of the art on the indications, methods of implementation and medico-economic considerations of reusable flexible ureteroscopes (URSr) vs single use (URSuu)? Review of the literature (Pubmed) on reusable and single-use ureteroscopes, as well as on the expertise of our center. A PubMed search and narrative review of the data was performed in July 2021. Only articles in French or English were selected. The URSr and URSuu have similar technical characteristics and are suitable for the exploration of the upper urinary excretory tract: treatment of stones of the kidney <2cm or of the ureter. The URSr is the most common type of ureteroscope. URSuu are newer and associated with many advantages: no sterilization procedure, immediate availability of equipment in the operating room, reduced waste production at the institutional level. A hybrid use of URSr and URSuu currently seems to be the best compromise from a medico-economic point of view for high volume centers. In the case of a smaller activity or a secondary site, URSuu are more advantageous and the reduction in purchasing costs should accentuate this benefit. URSr and URSuu are technically similar and allow identical treatment of upper urinary tract pathologies. Their complementary use optimizes the care of urology patients. The barrier to the exclusive use of URSuu remains their cost.

Comparison Between Single-Use Flexible Ureteroscope and Reusable Flexible Ureteroscope for Upper Urinary Calculi: A Systematic Review and Meta-Analysis.

Objective: This article explores the differences in the effectiveness and safety of the treatment of the upper urinary calculi between single-use flexible ureteroscope (su-fURS) and reusable flexible ureteroscope (ru-fURS).Methods: We systematically searched PubMed, Embase, Cochrane Library, Scopus database, and CNKI databases within a period from the date of database establishment to November 2020. Stata 16 was used for calculation and statistical analyses.Results: A total of 1,020 patients were included in the seven studies. The statistical differences were only found in the Clavien–Dindo grade II postoperative complication [odds ratio (OR) 0.47; 95% CI 0.23–0.98; p = 0.04]. No significant statistical differences were observed in operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), and stone-free rate (SFR).Conclusion: Our meta-analysis results demonstrate that su-fURS, compared with ru-fURS, has similar effectiveness and better security for treating upper urinary calculi.

Reusable flexible ureteroscope repair rate and cost may make disposable devices a better option

Reusable flexible ureteroscope repair rate and cost may make disposable devices a better option