Single-use Scopes Research Articles

Workflow efficiencies for flexible cystoscopy: comparing single-use vs reusable cystoscopes

BackgroundFlexible cystoscopy is a common procedure to diagnose and treat lower urinary tract conditions. Single-use cystoscopes have been introduced to eliminate time-consuming reprocessing and costly repairs. We compared the hands-on labor time differences between flexible reusable cystoscopes versus Ambu’s aScope™ 4 Cysto (aS4C) at a large urology Ambulatory Surgery Center (ASC).MethodsReusable and single-use cystoscopy procedures were shadowed for timestamp collection for setup and breakdown. A subset of reusable cystoscopes were followed through the reprocessing cycle. T-tests were calculated to measure the significance between groups.ResultsThe average hands-on time necessary for reusable cystoscope preparation, breakdown, and pre-cleaning was 4′53″. Of this, 2′53″ were required for preparation, while 2′0″ were required for breakdown and pre-cleaning. The average hands-on time for reprocessing for reusable was 7’1” per cycle. The total time for single-use scopes was 2′22″. Of this, 1′36″ was needed for single-use preparation, and 45 s for breakdown. Compared to reusable cystoscopes, single-use cystoscopes significantly reduced pre and post-procedure hands-on labor time by 2’31”, or 48%. When including reprocessing, total hands-on time was 80% greater for reusable than single-use cystoscopes.ConclusionSingle-use cystoscopes significantly reduced hands-on labor time compared to reusable cystoscopes. On average, the facility saw a reduction of 2′31″ per cystoscope for each procedure. This translates to 20 additional minutes gained per day, based on an 8 procedures per day. Utilizing single-use cystoscopes enabled the facility to reduce patient wait times, decrease turnaround times, and free up staff time.

Innovations in Endourologic Stone Surgery: Contemporary Practice Patterns from a Global Survey.

Objective: The purpose of this study is to evaluate the current availability of technology for urolithiasis treatment and ureteroscopy (URS). Perioperative practice patterns, availability of ureteroscopic technologies, pre- and poststenting practices, and methods to alleviate stent-related symptoms (SRS) were assessed via a survey of members of the Endourological Society. Methods: We distributed a 43-question survey online via the Qualtrics platform to members of the Endourological Society. The survey consisted of questions pertaining to the following topics: general (6), equipment (17), preoperative URS (9), intraoperative URS (2), and postoperative URS (9). Results: A total of 191 urologists responded to the survey and 126 completed all questions of the survey (66%). Fifty-one percent (65/127) of urologists were fellowship trained and dedicated an average of 58% of their practice to stone management. In terms of procedures, most urologists performed URS most commonly (68%), followed by percutaneous nephrolithotomy (23%) and extracorporeal shockwave lithotripsy (11%). Ninety percent (120/133) of respondent urologists purchased a new ureteroscope within the last 5 years (16% single-use scopes, 53% reusable, and 31% purchased both). Fifty-three percent (70/132) of the respondents stated that they would be interested in a ureteroscope that can sense intrarenal pressure, with an additional 28% (37/132) stating they would be interested depending on the cost. Seventy-four percent (98/133) of responders purchased a new laser within the last 5 years, and 59% (57/97) changed their lasering technique due to the new laser. Urologists are performing primary ureteroscopy for obstructing stones in 70% of cases, and prefer prestenting patients for subsequent URS in 30% (on average after 21 days). Seventy-one percent (90/126) of responders insert a ureteral stent after uncomplicated URS, which is removed, on average, after 8 days in uncomplicated cases and 21 days after complicated URS. Most urologists give analgesics, alpha-blockers, and anticholinergics for SRS and <10% prescribe opioids. Conclusion: Our survey revealed urologists' eagerness for the early adoption of novel technologies and adherence to conservative practice patterns focused on patient safety.

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.

PD34-07 CAN CONVOLUTIONAL NEURAL NETWORK BE APPLIED TO THE PREDICTION OF URINARY STONE COMPOSITION IN SINGLE-USE FLEXIBLE URETEROSCOPIC IMAGES?

You have accessJournal of UrologyCME1 Apr 2023PD34-07 CAN CONVOLUTIONAL NEURAL NETWORK BE APPLIED TO THE PREDICTION OF URINARY STONE COMPOSITION IN SINGLE-USE FLEXIBLE URETEROSCOPIC IMAGES? Kyung Tak Oh, Dae Young Jun, Jae Young Choi, Dae Chul Jung, and Joo Yong Lee Kyung Tak OhKyung Tak Oh More articles by this author , Dae Young JunDae Young Jun More articles by this author , Jae Young ChoiJae Young Choi More articles by this author , Dae Chul JungDae Chul Jung More articles by this author , and Joo Yong LeeJoo Yong Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003327.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This study investigated whether 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. METHODS: This study retrospectively used surgical videos of fURS performed by a single surgeon using single-use scope (LithoVue) between 2018 and 2021. Digital images of the surface of the stone before laser fragmentation were captured in the surgical full HD video clips. Cases were divided into two groups according to whether they contained any calcium oxalate (Calcium group) or not (Non-calcium group). Among total 512 cases, 207 of stone surface images were finally included. Among total images, 25 were first designated as the test set, then augmentation for Non-calcium group was performed. The train set and validation set were divided by random split in an 8 to 2 ratio. In the CNN model, Resnet-18 model was used, and only endoscopic digital images and stone classification data were input to achieve minimal supervised learning (Fig 1). RESULTS: There were 175 cases in the Calcium group, and 32 cases in the Non-calcium group. After whole training, in validation set, the total accuracy was 82.0%, and recall, specificity and precision for Calcium group was 80.0%, 83.3% and 76.2%, and for Non-calcium group, it was 83.3%, 80.0% and 86.2%, respectively. Area under ROC curve of the model, which represents the classification performance of the model, was 0.863. After training and validation, the model was tested using the test set, and the total accuracy was 84.0%. Recall, specificity and precision of the test result was 80.0%, 100.0% and 100.0% in Calcium group, and 100.0%, 80.0% and 55.6% in Non-calcium group, respectively (Fig 2). CONCLUSIONS: As far as we know, this study is the first artificial intelligence study using a single-use fURS images. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e922 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kyung Tak Oh More articles by this author Dae Young Jun More articles by this author Jae Young Choi More articles by this author Dae Chul Jung More articles by this author Joo Yong Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

MP26-20 RANDOMIZED TRIAL OF SINGLE-USE VERSUS REUSABLE CYSTOSCOPE FOR URETERAL STENT REMOVAL

You have accessJournal of UrologyCME1 Apr 2023MP26-20 RANDOMIZED TRIAL OF SINGLE-USE VERSUS REUSABLE CYSTOSCOPE FOR URETERAL STENT REMOVAL Brett Johnson, Jay Raman, Best Sara, and Yair Lotan Brett JohnsonBrett Johnson More articles by this author , Jay RamanJay Raman More articles by this author , Best SaraBest Sara More articles by this author , and Yair LotanYair Lotan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003254.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reusable cystoscopes are associated with risks of cross-contamination, need for chemical reprocessing, mechanical breakdown, manpower for cleaning and maintenance costs. A sterile, single use cystoscope may reduce or eliminate the source of these infections, while also decreasing exposure to reprocessing chemical agents. This multicenter, prospective randomized trial compared single-use vs. reusable endoscope for removal of ureteral stents. METHODS: The evaluation of a single-use cystoscope (Ambu A/S) was completed in a prospective, randomized, dual-arm post-market clinical trial to directly compare its performance to standard of care (SOC) flexible reusable cystoscopes in the removal of ureteral stents in an outpatient setting. 102 patients were evaluated from baseline through day 10 post-procedure at three investigative sites. The primary endpoint was the success rate of the stent removal procedures, delineated by single-use or reusable cystoscope. Secondary endpoints included time from preparation to disposal or reprocessing preparation, urologic adverse events 0-10 days, and a post-procedure clinician satisfaction survey. RESULTS: There were 102 subjects, randomized 1:1 between the single-use scope and SOC reusable scope. The successful stent removal rate was 51/51 for SOC group and 50/51 for single-use group (p=1.00). One patient required the conversion to a reusable scope due to a grasper passage issue with the index scope. There was no statistical difference in the time from scope insertion to procedure completion between the study arms. Median time from prep for the procedure to disposal/prep for reprocessing was 611 sec. for the single-use and 1105 sec. for the reusable (p=0.00). Reprocessing time was not evaluated in study. The 5-point survey demonstrated no difference in clinician satisfaction between both arms across all parameters addressed, as seen in the Clinician Satisfaction Table. There was no difference in adverse events between arms and no device causal attribution for any adverse events reports. One serious adverse event required hospitalization for infection in the SOC arm. CONCLUSIONS: The RCT of single-use cystoscopes vs. reusables showed comparable device success with significant time savings for single-use and equal clinician satisfaction. Source of Funding: Ambu USA sponsored this trial. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e361 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brett Johnson More articles by this author Jay Raman More articles by this author Best Sara More articles by this author Yair Lotan More articles by this author Expand All Advertisement PDF downloadLoading ...

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.

Pros and cons of single-use scopes

Gastrointestinal NursingVol. 20, No. Sup1 EditorialPros and cons of single-use scopesBenjamin WakefieldBenjamin WakefieldEditorSearch for more papers by this authorBenjamin WakefieldPublished Online:17 Feb 2022https://doi.org/10.12968/gasn.2022.20.Sup1.S3AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Beilenhoff U. Reviewing use of simeticone in gastrointestinal endoscopy. Gastrointestinal Nursing. 2022; 20(S1):S6–S7. https://doi.org/10.12968/gasn.2022.20.Sup1.S7 Link, Google ScholarDonnelly L. Endoscopy and the environment: scoping a sustainable future. Gastrointestinal Nursing. 2021; 19(S8):S3–S4. https://doi.org/10.12968/gasn.2021.19.Sup8.S3 Link, Google ScholarGlobal News Wire. Ambu receives FDA clearance for its sterile, single-use duodenoscope. 2020. https://tinyurl.com/2nydbvf3 (accessed 11 February 2022) Google ScholarNS Medical Devices. FDA approves Ambu's single-use gastroscope and advanced display unit. 2022. https://tinyurl.com/2p8vrb7v (accessed 11 February 2022) Google Scholar FiguresReferencesRelatedDetails 1 February 2022Volume 20Issue Sup1ISSN (print): 1479-5248ISSN (online): 2052-2835 Metrics History Published online 17 February 2022 Published in print 1 February 2022 Information© MA Healthcare LimitedPDF download

Single-use products in endoscopy-from consumables to single-use scopes

Wie in diversen Fallberichten und prospektiven Studien beschrieben stellen flexible Endoskopien einen potenziellen Risikofaktor für klinisch relevante Infektionen dar. Bei den Übertragungswegen sind dabei endogene Infektionen, ausgelöst durch eine Verschleppung der körpereigenen Mikroorganismen des jeweiligen Patienten, von exogenen Infektionen, die durch eine Übertragung von kontaminiertem Material oder Endoskopen entstehen, zu unterscheiden. Um das Problem der steigenden Zahl bekannter, exogener Infektionen zu minimieren, wurden von der Industrie Einmalendoskope entwickelt und für den klinischen Einsatz zertifiziert. Einmalbronchoskope sind bereits seit Jahren Bestandteil der klinische Routineversorgung, Einmalduodenoskope wurden erst kürzlich zugelassen. Die Nutzung von Einmalendoskopen stellt vordergründig eine finanzielle Mehrbelastung des Gesundheitssystems dar. Neben den reinen Sachkosten der Einmalendoskope sind aber insbesondere auch die vermeidbaren Kosten klinische relevanter Infektionen, wie verlängerter Krankenhausaufenthalt, intensivmedizinische Behandlung und Folgeeingriffe, in der Gesamtkalkulation zu berücksichtigen. Unabhängig von betriebs- und volkswirtschaftlichen Überlegungen steht die Patientensicherheit im Zentrum pflegerischen und ärztlichen Handelns.

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.

MP10-12 COST-EFFECTIVENESS OF 90-DAY SINGLE-USE FLEXIBLE CYSTOSCOPE TRIAL: SINGLE CENTER MICRO-COSTING ANALYSIS

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (MP10)1 Sep 2021MP10-12 COST-EFFECTIVENESS OF 90-DAY SINGLE-USE FLEXIBLE CYSTOSCOPE TRIAL: SINGLE CENTER MICRO-COSTING ANALYSIS Mark Assmus, Amy Krambeck, Matthew Lee, Deepak Agarwal, Matthew Mellon, Marcelino Rivera, and Tim Large Mark AssmusMark Assmus More articles by this author , Amy KrambeckAmy Krambeck More articles by this author , Matthew LeeMatthew Lee More articles by this author , Deepak AgarwalDeepak Agarwal More articles by this author , Matthew MellonMatthew Mellon More articles by this author , Marcelino RiveraMarcelino Rivera More articles by this author , and Tim LargeTim Large More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001983.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Use of flexible cystoscopy for hospital based urologic care (Emergency Department, intra-operative, inpatients) is invaluable for many urologic diseases. Reusable flexible cystoscopes have widespread utilization with known associated upfront purchasing, processing and service costs. Advances in single-use flexible cystoscope development have introduced alternative options to reusable flexible cystoscopes. However, there is a paucity of cost-effectiveness studies examining implementation of a hospital based transition to single-use scopes. Our primary objective was a 90-day cost-effectiveness evaluation of utilizing single-use flexible cystoscopes at a tertiary care center. METHODS: Following institutional device-approval we initiated a 90-Day trial period (November 1, 2020 - January 29, 2021) where urologic care was provided with a single-use disposable AMBU® aScopeTM 4 Cysto with reusable flexible cystoscopy only in cases where the single-use scope failed or was unavailable. We performed a micro-costing analysis examining per case cost of reusable flexible cystoscopy (including all servicing and processing costs) to the cost of the single-use. RESULTS: Over the 90 day period, we encountered 85 cases (78 operative, 6 inpatient, 1 ED) where flexible cystoscopy was required. 78/85 (92%) cases were successfully completed with one single-use disposable flexible cystoscope. Of the 7 failures, 4 were intraoperative cases where the AMBU scope failed to complete the required surgery and a reusable flexible cystoscope was required and 3 where access to the AMBU scope/monitor resulted in transition to reusable cystoscope use. Per use cost of the reusable flexible cystoscope at our center was $272.41 while per use cost for the single-use is $185.00. Accounting for backup reusable scopes for disposable failures at a rate of 3 uses/month, extrapolating our data over an average 3 month period results in $9,785.71 cost savings or $39,142.84 annually. CONCLUSIONS: This single center 90-Day trial of single-use flexible cystoscopies identified that based on our micro-costing analysis, per-use costs favor transitioning to single-use flexible cystoscopes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e173-e173 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mark Assmus More articles by this author Amy Krambeck More articles by this author Matthew Lee More articles by this author Deepak Agarwal More articles by this author Matthew Mellon More articles by this author Marcelino Rivera More articles by this author Tim Large More articles by this author Expand All Advertisement Loading ...

Single-use flexible ureteroscopes: how to choose and what is around the corner?

The pace of technology development with single-use endoscopy has led to a range of disposable ureteroscopes. We review the development of single-use scopes, deconstruct the basic design and functional characteristics of available devices, and discuss future directions for next-generation platforms. Currently available devices are differentiated on the basis of several core features. The optical, deflection and irrigation characteristics are marginally different with no device clearly superior in every category. Studies comparing single-use ureteroscopes in patients linked to outcomes are limited. The incorporation of next-generation technologies into these platforms include sensors to monitor intrarenal pressure and temperature, suction of fluid and fragments, and computer vision for artificial intelligence. Each ureteroscope has specific features that may be advantageous in different circumstances. Single-use devices could transform the ureteroscope from a visual conduit to a transformative surgical instrument that improves outcomes and reduces complications.

Cost comparison of single-use versus reusable flexible ureteroscope: A systematic review

Single-use flexible ureteroscopes (su-fURS) aim at overcoming the main limitations of conventional reusable flexible ureteroscopes (re-fURS) in terms of acquisition and maintenance costs, breakages, and reprocessing. We aimed to perform a literature review on available re-fURS and su-fURS performances with a focus on costs. A search of Medline, EMBASE, CINAHL, and Scopus databases was performed to identify articles published in English within the last 10 years addressing refURS and su-fURS characteristics, clinical, and cost data. Relevant studies were then screened, and the data were extracted, analyzed, and summarized. The Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria were applied. A narrative synthesis was performed. To date, few studies have properly investigated the issue of costs in ureteroscopy. An important local and international variation in costs exists for both re-fURS and su-fURS in terms of acquisition, maintenance, and repair costs. Reusable scopes have high acquisition and ancillary (e.g. repair, involved personnel) costs, which are not considered in a pure su-fURS activity. However, only recently su-fURS were shown to have a similar efficacy as compared with reusable devices. In high-volume centers, with proper training for reusable ureteroscopes management, the cost per case of reusable and single-use scopes are overlapping ($1,212-$1,743 versus $1,300-$3,180 per procedure). There is a partial overlap in the ranges of costs for single-use and reusable scopes, which makes it important to precisely know the caseload, repair bills, and added expenses when negotiating purchase prices, repair prices, and warranty conditions for scopes.

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.

IJU this issue

This issue contains three Review Articles, four Original Articles and four Urological Notes. Huge differences in the incidence and mortality rate of prostate cancer were detected between the USA and Japan. Such differences, however, have been decreasing over time, and were only twofold in 2017. Ito et al. (Takasaki, Japan) describe the important issue of screening for prostate cancer. They propose their screening strategies based on baseline prostate-specific antigen with a reasonable incremental cost-effectiveness ratio. In their perspectives, prostate cancer management might not only be aimed at decreasing the mortality of prostate cancer, but also aimed at achieving a significant increase in the quality-adjusted life year with an acceptable incremental cost-effectiveness ratio. The cancer-specific mortality among patients with localized prostate cancer has been reported to be very low irrespective of the treatment modalities. Nakamura et al. (Hamamatsu, Japan) focus on the patients’ quality of life after external beam radiotherapy using X-ray for prostate cancer, compared with other modalities, including radical prostatectomy and brachytherapy. In conclusion, the patients’ quality of life after external beam radiotherapy is strongly related to the total dose, fractionation regimens, dose parameters of the critical organs, beam delivery techniques and treatment plan quality, with a trade-off between the radicality of external beam radiotherapy and potentially increased toxicity. Particle beam radiotherapy (RT) for prostate cancer in Japan has changed considerably, and it is eligible for insurance coverage as of April 2018. Ishikawa et al. (Tsukuba, Japan) review the results of previous particle beam RT studies compared with photon beam RT, and introduce ongoing studies and prospects to establish high-quality evidence for particle beam RT for prostate cancer. Androgen deprivation therapy (ADT), a standard treatment for metastatic and locally advanced prostate cancer, is known to increase the risks of osteoporosis and fractures. Kimura et al. (Tokyo, Japan) prospectively investigated changes in bone quality, turnover markers and bone mineral density before and after ADT in castration-sensitive prostate cancer. They found that bone quality markers did not change significantly after ADT, whereas bone mineral density decreased significantly after ADT. Bone turnover markers might play an important role in monitoring bone health during ADT. Simone et al. (Rome, Italy) carried out propensity score-matched analysis to compare long-term renal functional outcomes after either off-clamp partial nephrectomy (PN) or on-clamp PN in patients with cT1–2/N0 M0 renal tumors. This study shows that off-clamp PN is associated with a significantly higher probability of maintaining 100% estimated glomerular filtration rate after surgery compared with on-clamp PN in patients with good baseline renal function. It also showed that patients treated with on-clamp PN had a 7.3-fold increased risk of developing a severe chronic kidney disease during long-term follow up. Molecular-targeted therapies have been generally used for treatment of metastatic renal cell carcinoma (mRCC), resulting in improvement in prognoses of mRCC. Konishi et al. (Hirosaki, Japan) retrospectively investigated the impact of C-reactive protein/albumin ratio (CAR) on prognosis, and the effect of adding CAR in the International Metastatic Renal Cell Carcinoma Database Consortium model for prognosis discrimination in Japanese patients who were treated with first-line tyrosine kinase inhibitor for mRCC. They concluded that CAR is an independent predictor of prognosis in patients with mRCC. Predictive activity was significantly improved in the International Metastatic Renal Cell Carcinoma Database Consortium-CAR model compared with the International Metastatic Renal Cell Carcinoma Database Consortium model. Kam et al. (Sydney, Australia) compared the operative performance of two single-use digital flexible ureteroscopes (fURS) with a reusable video fURS in order to show that single-use fURS would have a similar performance to reusable fURS with a lower scope failure rate. In conclusion, these single-use scopes offer a feasible alternative to reusable fURS, especially in complex stone cases where the risk of scope damage is high. None declared.

Reusable flexible ureterorenoscopes are more cost-effective than single-use scopes: results of a systematic review from PETRA Uro-group.

Clinical data suggest an equipoise between single-use (disposable) and reusable flexible ureterorenoscope (fURS) in terms of scope characteristics, manipulation, view and clinical outcomes. The procedural cost of reusable fURS is dependent on the initial and repair cost, maintenance and scope sterilization and on the number of procedures performed/repair. We conducted a systematic review on the procedural cost ($) of fURS based on the individual authors reported data on the number of procedures performed before repair and to see if it is a feasible option compared to single use fURS. A systematic review carried out in a Cochrane style and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist using Medline, Scopus, CINAHL, EMBASE and Cochrane library for all English language articles. All papers on fURS cost analysis were searched from 2000-2018 (19 years), which mentioned the cost of fURS based on the number of procedures performed and the repairs needed (procedure/repair) as reported by the individual authors. Six studies reported on both the number of procedures performed with number of repairs needed and the cost calculated/procedure in the given time period. The number of uses/repair in various studies varied between 8-29 procedures and the cost per procedure varied between $120-1,212/procedure. A significant trend was observed between the decreasing cost of repair with the number of usages. With studies reporting on a minimum of 20 cases/repair the mean cost was around $200/procedure. This is contrast to the disposable scopes such as Lithovue ($1,500-2,000/usage) and Pusen ($700/usage). The cost of reusable fURS is low in centres performing a high volume of procedures. Similarly, when a reasonable volume of procedures is performed before scope repair, the cost is lower than the disposable scopes. Although, the disposable and reusable scopes seem to be comparable in terms of their performance, this review proves that reusable fURS are still more cost effective than disposable scopes.

Characteristics of current digital single-use flexible ureteroscopes versus their reusable counterparts: an in-vitro comparative analysis.

Single-use flexible ureterorenoscopes (fURSs) have been recently introduced aiming to offer solutions to the sterilization, fragility and cost issues of the reusable fURSs. In order to be a viable alternative, the single-use scopes must prove similar capabilities when compared to their reusable counterparts. The goal of our in-vitro study was to compare the current reusable and single-use digital fURSs regarding their deflection, irrigation and vision characteristics. We compared in-vitro 4 single-use fURSs-LithoVue™ (Boston Scientific, Marlborough, Massachusetts, USA), Uscope™ (Zhuhai Pusen Medical Technology Co. Ltd., Zhuhai, Guangdong Province, China), NeoFlex™ (NeoScope Inc, San Jose, California, USA) and ShaoGang™ (YouCare Technology Co. Ltd., Wuhan, China) versus 4 reusable fURSs-FLEX-Xc (Karl Storz SE & Co KG, Tuttlingen, Germany), URF-V2 (Olympus, Shinjuku, Tokyo, Japan), COBRA vision and BOA vision (Richard Wolf GmbH, Knittlingen, Germany). Deflection and irrigation abilities were evaluated with different instruments inserted through the working channel: laser fibres (200/273/365 µm), retrieval baskets (1.5/1.9/2.2 Fr), guide wires [polytetrafluoroethylene (PTFE) 0.038 inch, nitinol 0.035 inch] and a biopsy forceps. A scoring system was designed to compare the deflection impairment. Saline at different heights (40/80 cm) was used for irrigation. The flow was measured with the tip of the fURS initially straight and then fully deflected. The vision characteristics were evaluated (field of view, depth of field, image resolution, distortion and colour representation) using specific target models. Overall, the single-use fURSs had superior in-vitro deflection abilities than the reusable fURSs, in most settings. The highest score was achieved by NeoFlex™ and the lowest by ShaoGang™. PTFE guide wire had most impact on deflection for all fURSs. The 200 µm laser fibre had the lowest impact on deflection for the single-use fURSs. The 1.5 Fr basket caused the least deflection impairment on reusable fURSs. At the end of the tests, deflection loss was noted in most of the single-use fURSs, while none of the reusable fURSs presented deflection impairment. ShaoGang™ had the highest irrigation flow. Increasing the size of the instruments occupying the working channel led to decrease of irrigation flow in all fURSs. The impact of maximal deflection on irrigation flow was very low for all fURSs. When instruments were occupying the working channel, the single-use fURSs had slightly better in-vitro irrigation flow than the reusable fURSs. The field of view was comparable for all fURSs, with LithoVue™ showing a slight advantage. Depth of field and colour reproducibility were almost similar for all fURSs. ShaoGang™ and Uscope™ had the lowest resolution. FLEX Xc had the highest image distortion while LithoVue™ had the lowest. Partial field of view impairment was not for Uscope™ and ShaoGang™. In-vitro, there are differences in technical characteristics of fURSs. It appears that single-use fURSs deflect better than their reusable counterparts. Irrespective of deflection, the irrigation flow of the single-use fURSs was slightly superior to the flow of the reusable fURSs. Overall, reusable fURSs had better vision characteristics than single-use fURSs. Further in-vivo studies might be necessary to confirm these findings.

Emerging next-generation robotic colonoscopy systems towards painless colonoscopy.

Advances in the field of robotics have allowed modern technology to be integrated into medicine and that can minimize patients suffering from the side effects that are inherent to procedures for improving their quality of life. Conventional devices that are used for colonoscopies are rigid and require a high level of expertise from endoscopists to perform the procedure. Advances in robot‐assisted colonoscopic systems now produce softer, more slender, automated designs that no longer require the operator to use forceful pushing to advance the colonoscope inside the colon, reducing risks to the patient of perforation and pain. It is challenging to reprocess these scopes for reuse as the materials used can be damaged during decontamination, leading to the possible risks of cross‐infection by pathogenic microorganisms when reused by patients. An ideal solution is to eliminate these contamination risks to patients by adopting sterile, single‐use scopes straight from the manufacturer's package to the patient.With this idea in mind, emerging developments that push the boundaries in this area will benefit patients and encourage the public to participate in and adhere better to colonoscopy screening to reduce the development of colorectal cancer. Thus, in light of these concerns and challenges, to encourage patients undergoing colorectal screening to comply with colonoscopy procedures that they are less invasive, changes in the design and materials are necessary. One of the more promising technological advances in this area is the advent of robotic colonoscopy.

Comparative Study on Environmental Impacts of Reusable and Single-Use Bronchoscopes

The introduction of single-use alternatives has stressed the need for environmental comparisons between reusable and single-use devises in the healthcare sector. Discarding of single-use devices intuitively causes concern among staff in hospitals, other users and people with environmental concerns as to whether the single use is environmentally friendly. This study aims to compare carbon dioxide (CO2)-equivalent emissions and resource consumption from a single-use bronchoscope (Ambu® aScopeTM 4) to a reusable flexible bronchoscope. The comparison is made using a simplified life-cycle-assessment methodology. The analysis shows that the materials used for the cleaning operations of the reusable scopes are a key factor affecting the impact factors assessed; energy consumption, emission of CO2-equivalent and consumption of scarce resources. Initially, it is assumed that each reusable scope is cleaned using one set of personal protective equipment (PPE) per cleaning operation, but since cleaning practice may vary the consequence of cleaning more scopes with one set of PPE is also assessed. Using one set of protective wear per operation and the materials for cleaning and disinfection determine that reusable scopes have comparable or higher material and energy consumption as well as higher emissions of CO2-equivalents and values of resource consumption. Cleaning two or more reusable scopes per set of PPE makes the impacts fairly comparable. Other aspects that may impact the results are also assessed, including energy consumption for washing and drying units, differences in use of PPE and differences in the disposal of PPE or single-use scopes. As the three assessed parameters are highly dependent on cleaning procedures and the use of protective equipment, it cannot be concluded from these results which type of bronchoscope affects the environmental factors investigated here the most.

Comparison of VividTrac\xae, Airtraq\xae, King Vision\xae, Macintosh Laryngoscope and a Custom-Made Videolaryngoscope for difficult and normal airways in mannequins by novices

BackgroundDirect laryngoscopy remains the gold standard for endotracheal intubation and is preferred by experienced operators. However, an increasing number of reports currently support videolaryngoscopy, particularly for novice users. The widespread use of videolaryngoscopy may be limited due to financial limitations, especially in low-income countries. Therefore, affordable single-use scopes are now becoming increasingly popular. We sought to compare these new scopes with direct laryngoscopes and the previously tested videolaryngoscopes in mannequins by novices.MethodsFifty medical students were recruited to serve as novice users. Following brief, standardized training, students were asked to execute endotracheal intubation with each of the devices, including the Airtraq®, a custom-made videolaryngoscope, the King Vision®, the Macintosh laryngoscope and the VividTrac®, on an airway trainer (Laerdal Airway Management Trainer®) in normal and difficult airway scenarios. We evaluated the time to and the proportion of successful intubation, the best view of the glottis, esophageal intubation, dental trauma and user satisfaction.ResultsWe observed no differences in esophageal intubation. However, intubation-related times, the view of the glottis and operator satisfaction were significantly better throughout the study with the commercial videolaryngoscopes. In comparison, the custom-made videolaryngoscope performance proved to be similar to that of the Macintosh laryngoscope. The VividTrac® performance was similar (P > 0.05) or significantly better than that of the King Vision® in both scenarios.ConclusionsBased upon our results, the Airtraq®, King Vision® and VividTrac® were superior to the Macintosh laryngscope in both normal and difficult airway scencarios for novice users. In particular, our study is the first to report that the VividTrac® shows promise for further clinical evaluation.