Single-use Flexible Ureteroscope Research Articles

Safety of single-use flexible ureteroscopy for dusting of upper urinary tract calculi in children

BackgroundFlexible ureteroscopy offers numerous advantages, such as increased reach, superior stone-free rate, reduced risk of bleeding, minimal surgical trauma, and faster recovery time. There are few studies discussing the effectiveness of single-use flexible ureteroscopy in children, and none so far have addressed its safety. This study aims to evaluate the effectiveness and safety of a single-use flexible ureteroscope for treating upper urinary tract stones in children.MethodsThis study included children with single upper urinary tract stones measuring less than 2 cm who underwent single-use flexible ureteroscopy between October 2020 and January 2023. We assessed the following patient characteristics: age, gender, stone type, size, position, pre and postoperative stent placements, use of a ureteral access sheath, stone-free rate, operation duration, and the rate of complications. A patient was considered stone-free if there were no residual stone particles larger than 3 mm after surgery.ResultsFlexible ureteroscopy and holmium laser lithotripsy were undertaken for 44 participants, with an average age of 8.5 years (range: 2–16 years). The typical stone size was 14 mm (range: 6–20 mm). The average operation time was 74 min (range 35–110 min). Ureteral access sheaths were used in 81.8% (36 out of 44) of procedures. After a single FURS session, 86.36% (38 out of 44) of patients achieved stone-free status. Postoperative JJ stent application was noted in 86.4% (38 out of 44) of patients. Complications were categorized using the Calvien system, revealing that 25% (11 out of 44) of patients experienced mild hematuria, colic, and low-grade fever (Calvien I). No severe side effects like mucosal avulsion or ureteral perforation were reported.ConclusionIn the short-term, single-use flexible ureteroscopy is a safe and effective method for managing single renal and proximal ureteric stones, measuring 2 cm or less, in children.

OGBN V02 Robotic common bile duct clearance

Abstract Background A 44-yar old male patient presented with painful obstructive jaundice and bilirubin of 127 μmol/L. A Contrast Enhanced Computed Tomography (CECT) revealed dilated biliary tree as a result of obstructing stone in the proximal common bile duct (CBD). The patient underwent an Endoscopic Retrograde CholangioPancreatography (ERCP) and sphincterotomy which demonstrated pus in the bile duct, but also a stone impacted in the common hepatic duct which could not be extracted endoscopically. Therefore, a 7Fr pigtail stent was inserted. Subsequently, he was discharged home and re-admitted for an elective robotic cholecystectomy and bile duct clearance 6 weeks later. Methods Robotic CBD clearance was performed using DaVinciXi system, a 12mm Airseal and four 8mm robotic ports. The patient was supine with split legs(15 degrees), in reverse Trendelenburg position and left tilt. The CBD was dissected out, the anterior duct wall was delineated and longitudinal choledochotomy was carried out. A large stone was extracted through the choledochotomy site followed by removal of stent. Subsequently, a cholangioscopy was performed using a single-use flexible ureteroscope and no further stone disease was identified proximally or distally. Following this, a bile duct closure was performed using 4-0 Polydioxanone interrupted sutures and SutureCut Needle Driver. Results There were no intra- or post-operative complications. The patient made an excellent recovery from robotic common bile duct clearance and was discharged home less than 24 hours post procedure. Conclusions This video presentation highlights the technical aspects of robotic common bile duct clearance and demonstrates that the robotic system allows for accurate dissection and precise suturing which could reduce the risk of bile duct stricture.

Practice and results of retrograde intra-renal surgery using the Uscope PU3022a single-use flexible ureteroscope and Holmium laser in the management of upper urinary tract stones: observation of a reference centre in Guadeloupe, France

Practice and results of retrograde intra-renal surgery using the Uscope PU3022a single-use flexible ureteroscope and Holmium laser in the management of upper urinary tract stones: observation of a reference centre in Guadeloupe, France

Exploring ureteroscope design with computational fluid dynamics for improved intra-pelvic pressure.

High intra-pelvic pressure (IPP) during ureteroscopy can lead to complications including pyelovenous backflow, bleeding, and infection. Our primary goal was to identify the best cross-section and orientation of a ureteroscope within a Ureteral Access Sheath (UAS) to minimize IPP and maximize outflow. Our secondary goal was to validate our findings with a UAS prototype. To determine the optimal ureteroscope cross-section within a UAS, four ureteroscopes of equivalent cross-sectional area were simulated within a 10Fr UAS using computational fluid dynamics software COMSOL. We then created a corresponding prototype by securing a 3-0 monofilament suture at the inferior aspect of the 12 Fr outer UAS, inducing an offset to the ureteroscope. Mean flow volumes through a 10/12 Fr UAS occupied by a 9.5-Fr single-use flexible ureteroscope were compared (17 iterations) to those through our prototype UAS. During the simulation, the lowest IPP and highest outflow were seen with an offset circular ureteroscope (41% resistance) compared to a ureteroscope centered in the UAS. The unmodified UAS had an average volume of 30.0mL/min (SD ± 0.35) compared to 33.76mL/min (SD ± 0.90) for the modified UAS (p < 0.05). We found that using a circular ureteroscope positioned along the sidewall maximizes outflow through a circular UAS. We made a prototype UAS to offset the ureteroscope and observed a 12.5% increase in outflow. This approach can potentially decrease IPP during ureteroscopy without impacting inflow or the working channel. Although modifying a ureteroscope is more difficult, it could create an offset without reducing UAS cross-section.

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.

Predicting Urinary Stone Composition in Single-Use Flexible Ureteroscopic Images with a Convolutional Neural Network.

Background and Objectives: Analysis of urine stone composition is one of the most important factors in urolithiasis treatment. This study investigated whether a convolutional neural network (CNN) can show decent results in predicting urinary stone composition even in single-use flexible ureterorenoscopic (fURS) images with relatively low resolution. Materials and Methods: This study retrospectively used surgical images from fURS lithotripsy performed by a single surgeon between January 2018 and December 2021. The ureterorenoscope was a single-use flexible ureteroscope (LithoVue, Boston Scientific). Among the images taken during surgery, a single image satisfying the inclusion and exclusion criteria was selected for each stone. Cases were divided into two groups according to whether they contained any calcium oxalate (the Calcium group) or none (the Non-calcium group). From 506 total cases, 207 stone surface images were finally included in the study. In the CNN model, the transfer learning method using Resnet-18 as a pre-trained model was used, and only endoscopic digital images and stone classification data were input to achieve minimally supervised learning. Results: There were 175 cases in the Calcium group and 32 in the Non-calcium group. After training and validation, the model was tested using the test set, and the total accuracy was 81.8%. Recall and precision of the test results were 88.2% and 88.2% in the Calcium group and 60.0% and 60.0% in the Non-calcium group, respectively. The area under the receiver operating characteristic curve of the model, which represents its classification performance, was 0.82. Conclusions: Single-use flexible ureteroscopes have financial benefits but low vision quality compared with reusable digital flexible ureteroscopes. As far as we know, this is the first artificial intelligence study using single-use fURS images. It is meaningful that the CNN performed well even under these difficult conditions because these results can further expand the possibilities of its use.

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.

MP35-13 INITIAL EXPERIENCE AND CLINICAL ASSESSMENT OF A NOVEL SINGLE-USE FLEXIBLE URETEROSCOPE

You have accessJournal of UrologyCME1 Apr 2023MP35-13 INITIAL EXPERIENCE AND CLINICAL ASSESSMENT OF A NOVEL SINGLE-USE FLEXIBLE URETEROSCOPE Kevin Koo, Jamal Alamiri, Kevin Hanna, Lindsay White, Garrett Ungerer, Jayson Kemble, Carly Thompson, and Aaron Potretzke Kevin KooKevin Koo More articles by this author , Jamal AlamiriJamal Alamiri More articles by this author , Kevin HannaKevin Hanna More articles by this author , Lindsay WhiteLindsay White More articles by this author , Garrett UngererGarrett Ungerer More articles by this author , Jayson KembleJayson Kemble More articles by this author , Carly ThompsonCarly Thompson More articles by this author , and Aaron PotretzkeAaron Potretzke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003269.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Single-use (SU) ureteroscopes offer cost-effective advantages over traditional reusable devices in clinical settings with increased risk of device damage. One technical drawback of SU scopes is decreased brightness and clarity of the visual field, which may impair case completion. The Karl Storz FLEX-XC1 is a novel single-use flexible ureteroscope that uses the same video graphics platform as its reusable digital counterpart. We aimed to evaluate the technical performance of the XC1 in initial clinical use. METHODS: We reviewed a series of consecutive ureteroscopy procedures performed by 2 endourologists. We used the XC1 for indications in which we typically use a single-use device: stone burden >15 mm overall or >10 mm in the lower pole; expected case duration >60 min; bilateral procedure; distorted anatomy. For each case, we assessed pre-case tip deflection, intraoperative mechanical failure, and clinical outcomes. Surgeons rated visual clarity, image quality, and mechanical handling on a 1 to 5 Likert scale. RESULTS: A total of 21 procedures were attempted using XC1, and 20 (95%) were completed successfully. Pre-case incomplete deflection was noted in 7 (33%) cases: pre-case upward deflection was <270° in 4 (19%) cases (range 200-250°), and downward deflection was <270° in 5 (24%) cases (range 180-250°). Pre-case incomplete deflection did not preclude completion of any case. Three intraoperative malfunctions occurred: rotational twisting of the deflectable distal tip (2 cases, 10%) and inability to pass a 365-micron laser fiber fully through the working channel (1 case, 5%), requiring conversion to another device. Visual clarity, image quality, and mechanical handling were rated as 4 (very good) or 5 (excellent) in 100%, 100%, and 76% of cases. Figure 1 shows representative image quality between the reusable digital Storz FLEX-XC, SU Storz FLEX-XC1, and SU Dornier AXIS. No device-specific or general 30-day complications were observed. CONCLUSIONS: In this pilot trial of the FLEX-XC1, visual clarity and image quality were subjectively similar to reusable digital devices and rated highly by operators. We observed incomplete deflection in 33% of cases and mechanical failure in 1 case. XC1 may be advantageous in prolonged cases where maintaining visual clarity is paramount. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e474 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Koo More articles by this author Jamal Alamiri More articles by this author Kevin Hanna More articles by this author Lindsay White More articles by this author Garrett Ungerer More articles by this author Jayson Kemble More articles by this author Carly Thompson More articles by this author Aaron Potretzke More articles by this author Expand All Advertisement PDF downloadLoading ...

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 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.

Clinical Comparison between Three Single-Use Flexible Ureteroscope Models: A Real-World Experience

Introduction: Studies comparing different single-use flexible ureteroscope (su-fURS) models are lacking. The objective was to compare three types of su-fURS: the Uscope 3022 (PUSEN), LithoVue (Boston Scientific), and EU-scope (Innovex). Methods: This was a retrospective study comparing the clinical outcomes from patients undergoing flexible ureteroscopy with one of the three su-fURS for upper urinary tract stone treatment between September 2019 and 2021. Analysis included total surgery and fluoroscopy time, post-procedure ureteral catheter, stone-free rate (SFR), and complications. Results: There were 104 cases with the Uscope 3022, 141 with LithoVue, and 80 with EU-scope. Groups were comparable in terms of stone size, location and density, and prior double-J stent presence. Multivariate analysis showed no difference in terms of SFR: 79% (Uscope 3022), 77.5% (LithoVue), and 81% (EU-scope); p = 0.38. Significant differences were found for total surgery and fluoroscopy time, as well as ureteral access sheath use (p < 0.001), favoring the EU-scope group. Discussion/Conclusion: The three devices evaluated are highly effective in treatment of kidney stones. Reasons for difference in total surgery and fluoroscopy time and access sheath use are not clear. However, this could be explained by technical aspects of these devices, such as external diameter, optical resolution, and field of view.

Microdamage analysis of single-use flexible ureteroscope immediately after lithotripsy use

This prospective ex vivo study investigated microdamage to single-use flexible ureteroscopes (fURS) after ureteroscopy and endoscopic combined intrarenal surgery (ECIRS). The performance of 30 WiScope devices (OTU Medical, San Jose, CA, USA) was examined immediately after use, dividing them into three equal groups: ureteroscopy and ECIRS in the prone and supine positions. The overall scope of microdamage assessment included the scope deflection, bending radius, resolution, and water flow rate. Additionally, we analyzed the association between scope status and surgical parameters. The deflection, bending radius, and resolution remained similarly above the thresholds in all groups. However, the water flow rate was below the threshold in seven scopes (70%) in the ureteroscopy group and none in the ECIRS groups (P = 0.001). Univariate and multivariable logistic regression analyses demonstrated that basket wire catheter use was associated with an increased risk for overall scope microdamage (odds ratio [OR], 22.70; P = 0.006 and OR, 22.40; P = 0.019, respectively). Stone size, total laser energy, and surgical position were not associated with a risk for scope microdamage. In conclusion, ureteroscopy was more closely associated with scope damage than ECIRS, and basket wire catheter use seemed to inflict more damage to the fURS.

Single-use flexible ureteroscopes: update and perspective in developing countries. A narrative review.

ABSTRACTFlexible ureteroscopy is a well-established method for treatment of urinary stones but flexible ureteroscopes are expensive and fragile devices with a very limited lifetime. Since 2006 with the advent of digital flexible ureteroscopes a great evolution has occurred. The first single-use flexible ureteroscope was launched in 2011 and new models are coming to the market. The aim of this article is to review the characteristics of these devices, compare their results with the reusable devices and evaluate the cost-benefits of adopting single-use flexible ureteroscopes in developing countries.Materials and Methods:an extensive review of articles listed at PubMed and published between 2000 and 2021 was performed.Results:Single-use flexible ureteroscopes have a shaft with 65 to 68cm length and weight between 119 and 277g. Their deflection goes up to 300 degrees. Their stone-free rates vary between 60 and 95% which is comparable to reusable scopes and operative times ranges from 54 to 86 minutes which are lower when compared to reusable flexible scopes. Their costs vary between 800 and 3180 US dollars.Conclusion:single-use flexible ureteroscopes are lighter and have superior quality of image when compared to fiberoptic ones. There are no definite data showing a higher stone-free rate or less complications with the use of single-use flexible ureteroscopes. Each institution must perform a cost-benefit analysis before making the decision of adopting or not such devices depending on the local circumstances.

Single-Use vs. Reusable Digital Flexible Ureteroscope to Treat Upper Urinary Calculi: A Propensity-Score Matching Analysis.

Objective: The purpose of this research was to compare the treatment outcomes and costs of a single-use and reusable digital flexible ureteroscope for upper urinary calculi.Methods: Four hundred forty patients with reusable digital flexible ureteroscope and 151 patients with single-use flexible digital ureteroscope were included in this study. Through exclusion and inclusion criteria and 1:1 propensity-score matching analysis based on baseline characteristics, ultimately, 238 patients (119:119) were compared in terms of treatment outcomes. The cost analysis was based on the costs of purchase, repair, and reprocessing divided by the number of all procedures in each group (450 procedures with reusable digital flexible ureteroscope and 160 procedures with single-use digital flexible ureteroscope).Results: There was no statistical significance in mean operation time (P = 0.666). The single-use digital flexible ureteroscope group has a shorter mean length of hospital stay than the reusable digital flexible ureteroscope group (P = 0.026). And the two groups have a similar incidence of postoperative complications (P = 0.678). No significant difference was observed in the final stone-free rate (P = 0.599) and the probability of secondary lithotripsy (P = 0.811) between the two groups. After 275 procedures, the total costs of a single-use flexible ureteroscope would exceed the reusable flexible ureteroscope.Conclusion: Our data demonstrated that the single-use digital flexible ureteroscope is an alternative to reusable digital flexible ureteroscopy in terms of surgical efficacy and safety for upper urinary calculi. In terms of the economics of the two types of equipment, institutions should consider their financial situation, the number of FURS procedures, the volume of the patient's calculus, surgeon experience, and local dealerships' annual maintenance contract when making the choice.

3D printed model for flexible ureteroscopy training, a low-cost option for surgical training

IntroductionTraining in experimental models is a valid option that improves the outcomes and shortens surgical learning curves.Our objective was to develop a 3D printed plastic model for teaching, training and education in flexible ureteroscopy, analyzing costs and suitability for the practice of this surgical technique. MethodsA 3D printed model was developed based on a CT scan from a real-life patient’s upper urinary tract. Horos™ software was used for segmentation and an FDM-Ultimaker for 3D printing.Renal calyces were numbered to be identified, as in the European Association of Urology Endoscopic Stone Treatment training curriculum, Task 4.The following were used: Innovex single-use flexible ureteroscope (Palex) and nitinol baskets (Coloplast). ResultsPrinting time was 19 h, with a total cost of €8.77.The three-dimensional model allowed the insertion of the flexible ureteroscope and the exploration of the renal calyces by urologists in training as well as in current practice of the specialty without difficulty.The model also allowed the use of baskets and the mobilization and removal of previously placed stones. ConclusionWe unveil a valid three-dimensional model for flexible ureteroscopy training exercises with reasonable costs, which will allow acquiring the necessary skills and confidence to initiate the procedure in a real-life scenario.

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.

Modelo impreso en 3D para entrenamiento en ureteroscopia flexible, una opción de bajo coste para el entrenamiento quirúrgico

IntroductionTraining in experimental models is a valid option that improves the outcomes and shortens surgical learning curves.Our objective was to develop a 3D printed plastic model for teaching, training and education in flexible ureteroscopy, analyzing costs and suitability for the practice of this surgical technique. MethodsA 3D printed model was developed based on a CT scan from a real-life patient's upper urinary tract. HorosTM software was used for segmentation and an FDM-Ultimaker for 3D printing.Renal calyces were numbered to be identified, as in the European Association of Urology Endoscopic Stone Treatment training curriculum, Task 4.The following were used: Innovex single-use flexible ureteroscope (Palex) and nitinol baskets (Coloplast). ResultsPrinting time was 19hours, with a total cost of €8.77.The three-dimensional model allowed the insertion of the flexible ureteroscope and the exploration of the renal calyces by urologists in training as well as in current practice of the specialty without difficulty.The model also allowed the use of baskets and the mobilization and removal of previously placed stones. ConclusionWe unveil a valid three-dimensional model for flexible ureteroscopy training exercises with reasonable costs, which will allow acquiring the necessary skills and confidence to initiate the procedure in a real-life scenario.

Comparison of a single-use, digital flexible ureteroscope with a reusable, fiberoptic ureteroscope for management of patients with urolithiasis.

Ureteroscopy is one of the commonest procedures performed to manage urolithiasis. Flexible ureteroscopy has been traditionally based on reusable, fiber-optic ureteroscopes. Technology advancements permitted the development of single-use scopes with digital image. The aim of this study is to compare efficacy and safety between a reusable, fiberoptic ureteroscope with a single-use, digital scope. We collected data based on chart review from a prospectively collected database on a tertiary, high-volume hospital in Greece. Baseline, perioperative and postoperative data were gathered and analyzed. Chi-square and Fisher's exact test was used to compare qualitative data and unpaired t-test for continuous data, with a statistical significance set at a = 0.05. 40 patients underwent flexible ureteroscopy with a single- use digital scope, while 37 with the reusable scope. The two groups were matched regarding baseline characteristics and stone-related parameters. After data analysis, a shorter operative time in favor of single-use flexible ureteroscope was detected (45 vs 65 min, p = 0.001), while safety was also in favor of this type of scope with a significantly higher immediate stonefree rate (70% vs 43%, p = 0.005). Overall complications did not differ between the two groups, although a lower sepsis rate was detected in patients treated with single-use scope. Our findings indicate that single-use, digital ureteroscopes are a viable alternative for flexible ureteroscopy and management of urolithiasis, especially in centers with deficient facilities for sterilization and ensured funds for more expensive reusable scopes.

Single-Use Digital Flexible Ureteroscopes as a Safe and Effective Choice for the Treatment of Lower Pole Renal Stones: Secondary Analysis of a Randomized-Controlled Trial.

Objective: To compare the efficacy and safety of a single-use digital flexible ureteroscope (FURS) and a reusable FURS for the treatment of lower pole stones (LPS) smaller than 20 mm. Patients and Methods: We analyzed the data of 49 patients with LPS from our previous multicenter, randomized, open-label clinical trial in four hospitals in China. All patients underwent FURS for LPS with a single-use FURS ZebraScope™ (trial group) or a reusable FURS URF-V (control group). The efficacy endpoints assessed were the 1-month postsurgical stone-free rate (SFR), operative time, length of postoperative hospital stay, and mean reduction in hemoglobin level. The safety outcomes assessed were the presence of adverse events (AEs), severe AEs (SAEs), and postoperative complications. Results: The demographic and preoperative parameters were comparable between the two groups. The 1-month SFR was 84.00% for the ZebraScope group and 58.33% for the reusable flexible ureteroscope (URF-V) group (p < 0.05). There was no difference between the two groups in the operative time (p = 0.665), length of hospital stay (p = 0.308), presence of postoperative complications (p = 0.307), presence of AEs (p = 0.483), and the presence of SAEs (p = 0.141). Conclusions: This study demonstrates that single-use digital FURS is a safe and effective option and can offer higher SFR than the reusable FURS in the treatment of LPS smaller than 20 mm. We recommend single-use digital FURS as an alternative to reusable FURS for the treatment of LPS. The Clinical Trial Registration number: ChiCTR1900021615.

Evaluation of a Novel Female Gender Flexible Ureteroscope: Comparison of Flow and Deflection to a Standard Flexible Ureteroscope.

Introduction: The advent of single-use disposable flexible ureteroscopes allows for rapid prototyping of novel endoscopes. In this regard, we sought to develop a female-specific ureteroscope, with a shorter working length, to account for the female anatomy. We hypothesized that the shorter, female-specific single-use flexible ureteroscope would engender higher irrigation flow at a given pressure than that of the standard-length ureteroscope. Methods: An in vitro analysis of a standard 65 cm Dornier Axis™ ureteroscope and a shorter, 45 cm female-specific Dornier Axis ureteroscope was performed. All other aspects of the endoscopes were identical. Each ureteroscope was oriented vertically and connected to a Thermedx® irrigation system to provide uniform pressurized flow. The average flow rate was computed over five, 2-minute periods at pressure settings of 50, 100, 150, and 200 mm Hg. Data were collected with the working channel unoccupied, after placement of a 200 μm (0.6F) holmium laser fiber and after passage of a 1.7F stone basket. The procedure was then repeated with the endoscopes at maximum deflection. Results: The female gender ureteroscope had significantly higher irrigation flow rates than the standard-length ureteroscope under all conditions by an average of 11% (p < 0.02). The highest average percent increase, 17% (p < 0.001), was seen with the 1.7F NGage® basket in the working channel with the endoscope straight. The maximum angle of deflection was not significantly different between the female gender and standard ureteroscopes with an open working channel (314° vs 315°, p = 0.86), with the 1.7F NGage basket in place (314° vs 315°, p = 0.15), and with the 200 μm holmium laser in place (316° vs 309°, p = 0.09). Conclusions: A 45 cm female gender ureteroscope allows for a higher irrigation flow rate than the standard-length ureteroscope under all test conditions. There is no added benefit with regard to deflection capabilities.