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Talso M, Goumas IK, Kamphuis GM, Dragos L, Tefik T, Traxer O, Somani BK. Reusable flexible ureterorenoscopes are more cost-effective than single-use scopes: results of a systematic review from PETRA Uro-group. Transl Androl Urol 2019; 8:S418-S425. [PMID: 31656747 DOI: 10.21037/tau.2019.06.13] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Michele Talso
- Urology Department, Azienda Socio-Sanitaria Territoriale-(ASST) Vimercate Hospital, Vimercate, Italy
| | - Ioannis K Goumas
- Urology Department, Azienda Socio-Sanitaria Territoriale-(ASST) Vimercate Hospital, Vimercate, Italy
| | - Guido M Kamphuis
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Laurian Dragos
- Department of Urology, Victor Babeş University of Medicine and Pharmacy, Timisoara, Romania
| | - Tzevat Tefik
- Department of Urology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Olivier Traxer
- Department of Urology, Hôpital Tenon AP-HP, Sorbonne Université, Paris, France
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
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Hennessey DB. Editorial Comment to Single use versus reusable digital flexible ureteroscopes: A prospective comparative study. Int J Urol 2019; 26:1005-1006. [PMID: 31448434 DOI: 10.1111/iju.14094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kam J, Yuminaga Y, Beattie K, Ling KY, Arianayagam M, Canagasingham B, Ferguson R, Varol C, Khadra M, Winter M, Ko R. Single use versus reusable digital flexible ureteroscopes: A prospective comparative study. Int J Urol 2019; 26:999-1005. [PMID: 31448473 DOI: 10.1111/iju.14091] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the performance and surgical outcomes of two different single-use digital flexible ureteroscopes with a reusable video flexible ureteroscope. METHODS Patients undergoing retrograde flexible ureteroscopy at Nepean Hospital, Sydney, Australia, were included in this study. Three different flexible ureteroscopes were used in this study: (i) single-use digital LithoVue (Boston Scientific, Marlborough, MA, USA); (ii) single-use digital PU3022A (Pusen, Zhuhai, China); and (iii) reusable digital URF-V2 (Olympus, Tokyo, Japan). Visibility and maneuverability was rated on a 5-point Likert scale by the operating surgeon. Operative outcomes and complications were collected and analyzed. RESULTS A total of 150 patients were included in the present study. Of these, 141 patients had ureteroscopy for stone treatment, four for endoscopic combined intrarenal surgery and five for diagnostic/tumor treatment. There were 55 patients in the LithoVue group, 31 in the PU3022A group and 64 patients in the Olympus URF-V2 group. The URF-V2 group had higher visibility scores than both the single-use scopes and higher maneuverability scores when compared with the PU3022A. The LithoVue had higher visibility and maneuverability scores when compared with the PU3022A. There were no differences in operative time, rates of relook flexible ureteroscopes, scope failure or complication rates observed. CONCLUSIONS Single-use digital flexible ureteroscopes have visibility and maneuverability profiles approaching that of a reusable digital flexible ureteroscope. Single-use flexible ureteroscopes achieve similar clinical outcomes to the more expensive reusable versions.
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Affiliation(s)
- Jonathan Kam
- Nepean Urology Research Group, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of Newcastle, Newcastle, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Yuigi Yuminaga
- Nepean Urology Research Group, Sydney, New South Wales, Australia
| | - Kieran Beattie
- Nepean Urology Research Group, Sydney, New South Wales, Australia
| | - Koi Yi Ling
- Nepean Urology Research Group, Sydney, New South Wales, Australia
| | - Mohan Arianayagam
- Nepean Urology Research Group, Sydney, New South Wales, Australia.,Macquarie University, Sydney, New South Wales, Australia
| | | | - Richard Ferguson
- Nepean Urology Research Group, Sydney, New South Wales, Australia
| | - Celalettin Varol
- Nepean Urology Research Group, Sydney, New South Wales, Australia.,Macquarie University, Sydney, New South Wales, Australia
| | - Mohamed Khadra
- Nepean Urology Research Group, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Winter
- Nepean Urology Research Group, Sydney, New South Wales, Australia
| | - Raymond Ko
- Nepean Urology Research Group, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Macquarie University, Sydney, New South Wales, Australia
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Al-Balushi K, Martin N, Loubon H, Baboudjian M, Michel F, Sichez PC, Martin T, Di-Crocco E, Gaillet S, Delaporte V, Akiki A, Faure A, Karsenty G, Lechevallier E, Boissier R. Comparative medico-economic study of reusable vs. single-use flexible ureteroscopes. Int Urol Nephrol 2019; 51:1735-1741. [PMID: 31317310 DOI: 10.1007/s11255-019-02230-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Reusable flexible-ureteroscopes (fURS) require personnel and budget for processing and repairing, whereas single-use fURS were recently developed. After exclusive reusable fURS since 2011, we experienced high repair costs and single-use fURS were therefore introduced in mid-2017. We aimed to evaluate economic and practical advantages and disadvantages of reusable versus single-use fURS. MATERIALS AND METHODS First, we evaluated the incidence of breakage and repairs of reusable fURS in 2017. We assessed the overall operational costs of reusable fURS including purchase, processing, and repairing in our institution from 2011 to 2017. Following our experience, we created a model to compare operation costs/procedure of single-use fURS with reusable fURS depending on repair costs. RESULTS In 2017, repair costs of reusable fURS increased by 345% compared with the period 2011-2016, causing: a median unavailability per reusable fURS of 200 days/year (100-249), median number of functioning fURS 0/5-3/5 per operating day, while unavailability of reusable fURS had become the first reason for cancellation of procedure. Since it was introduced, single-use fURS accounted for 59% of the flexible ureteroscopy activity. Taking into account the costs of processing, maintenance and repair, in 2011-2016 versus 2017, the single-use fURS was cost-effective compared with the reusable fURS until the 22nd procedure versus the 73rd procedure, respectively. CONCLUSIONS After years of exclusive reusable fURS, the rising incidence of breakage not only increased maintenance costs but also hampered daily activity owing to unavailability of the devices. The introduction of single-use with reusable fURS provided substantial help to maintain our activity.
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Affiliation(s)
- Khalid Al-Balushi
- Department of Urology and Kidney Transplantation, APHM, Conception University Hospital, Aix-Marseille University, 13005, Marseille, France
| | - Nathalie Martin
- APHM, Conception University Hospital, Central Pharmacy, Marseille, France
| | - Hélène Loubon
- Department of Urology and Kidney Transplantation, APHM, Conception University Hospital, Aix-Marseille University, 13005, Marseille, France
| | - Michael Baboudjian
- Department of Urology and Kidney Transplantation, APHM, Conception University Hospital, Aix-Marseille University, 13005, Marseille, France
| | - Floriane Michel
- Department of Urology and Kidney Transplantation, APHM, Conception University Hospital, Aix-Marseille University, 13005, Marseille, France
| | - Pierre-Clément Sichez
- Department of Urology and Kidney Transplantation, APHM, Conception University Hospital, Aix-Marseille University, 13005, Marseille, France
| | - Thomas Martin
- Department of Urology and Kidney Transplantation, APHM, Conception University Hospital, Aix-Marseille University, 13005, Marseille, France
| | - Eugénie Di-Crocco
- Department of Urology and Kidney Transplantation, APHM, Conception University Hospital, Aix-Marseille University, 13005, Marseille, France
| | - Sarah Gaillet
- Department of Urology and Kidney Transplantation, APHM, Conception University Hospital, Aix-Marseille University, 13005, Marseille, France
| | - Veronique Delaporte
- Department of Urology and Kidney Transplantation, APHM, Conception University Hospital, Aix-Marseille University, 13005, Marseille, France
| | - Akram Akiki
- Department of Urology and Kidney Transplantation, APHM, Conception University Hospital, Aix-Marseille University, 13005, Marseille, France
| | - Alice Faure
- Department of Pediatric Surgery, APHM, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Gilles Karsenty
- Department of Urology and Kidney Transplantation, APHM, Conception University Hospital, Aix-Marseille University, 13005, Marseille, France
| | - Eric Lechevallier
- Department of Urology and Kidney Transplantation, APHM, Conception University Hospital, Aix-Marseille University, 13005, Marseille, France
| | - Romain Boissier
- Department of Urology and Kidney Transplantation, APHM, Conception University Hospital, Aix-Marseille University, 13005, Marseille, France.
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Kumarage J, Khonyongwa K, Khan A, Desai N, Hoffman P, Taori S. Transmission of multi-drug resistant Pseudomonas aeruginosa between two flexible ureteroscopes and an outbreak of urinary tract infection: the fragility of endoscope decontamination. J Hosp Infect 2019; 102:89-94. [DOI: 10.1016/j.jhin.2019.02.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/17/2019] [Indexed: 11/28/2022]
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Abstract
A PubMed search using the terms "single use" and "ureteroscope" was performed to identify published studies on this topic. In addition, the abstracts of the annual meeting of the World Congress of Endourology and the American Urologic Association since 2010 were reviewed. Here we present a review of published studies on single-use ureteroscopes.
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Affiliation(s)
- Brooke Moore
- Department of Urology, Massachusetts General Hospital, 55 Fruit Street, GRB 1102, Boston, MA 02114, USA
| | - Silvia Proietti
- Department of Urology, IRCCS San Raffaele Hospital, Ville Turro Division, Milan, Italy
| | - Guido Giusti
- Department of Urology, IRCCS San Raffaele Hospital, Ville Turro Division, Milan, Italy
| | - Brian H Eisner
- Department of Urology, Massachusetts General Hospital, 55 Fruit Street, GRB 1102, Boston, MA 02114, USA.
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Bayne DB, Chi TL. Assessing Cost-Effectiveness of New Technologies in Stone Management. Urol Clin North Am 2019; 46:303-313. [PMID: 30961862 DOI: 10.1016/j.ucl.2018.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Diagnosis, treatment, and follow-up are all influential in determining the overall cost to the health care system for kidney stones. New innovations in the field of nephrolithiasis have been abundant, including disposable ureteroscopes, ultrasound-guided approaches to percutaneous nephrolithotomy, and advanced laser lithotripters. Identifying cost-effective treatment strategies encourages practitioners to be thoughtful about providing value-based high-quality care and remains on important principle in the treatment of urinary stone disease.
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Affiliation(s)
- David B Bayne
- Urology, University of California San Francisco, San Francisco, CA, USA.
| | - Thomas L Chi
- Urology, University of California San Francisco, San Francisco, CA, USA
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59
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Hennig MJP, Knoll T, Struck JP. [Cost effectiveness of using disposable ureterorenoscopes for diagnosis and treatment]. Urologe A 2019; 58:172-174. [PMID: 30721328 DOI: 10.1007/s00120-019-0867-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M J P Hennig
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - T Knoll
- Klinikum Sindelfingen-Böblingen, Sindelfingen, Deutschland
| | - J P Struck
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
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60
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Scotland KB, Chan JY, Chew BH. Single-Use Flexible Ureteroscopes: How Do They Compare with Reusable Ureteroscopes? J Endourol 2019; 33:71-78. [DOI: 10.1089/end.2018.0785] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Kymora B. Scotland
- Department of Urologic Sciences, Faculty of Medicine, Gordon and Leslie Diamond Health Care Centre, University of British Columbia, Vancouver, Canada
| | - Justin Y.H. Chan
- Department of Urologic Sciences, Faculty of Medicine, Gordon and Leslie Diamond Health Care Centre, University of British Columbia, Vancouver, Canada
| | - Ben H. Chew
- Department of Urologic Sciences, Faculty of Medicine, Gordon and Leslie Diamond Health Care Centre, University of British Columbia, Vancouver, Canada
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61
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Winship B, Wollin D, Carlos E, Li J, Preminger GM, Lipkin ME. Avoiding a Lemon: Performance Consistency of Single-Use Ureteroscopes. J Endourol 2019; 33:127-131. [DOI: 10.1089/end.2018.0805] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brenton Winship
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Evan Carlos
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jingqiu Li
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Glenn M. Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael E. Lipkin
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
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Klein JT, Berger F, Linzenbold W, Jäger L, Enderle MD, Bösmüller H, Mundhenk J, Schwentner C, Bolenz C. Cryobiopsy in the Upper Urinary Tract: Preclinical Evaluation of a Novel Device. Urology 2018; 123:273-279. [PMID: 30312669 DOI: 10.1016/j.urology.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/21/2018] [Accepted: 10/02/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To develop a novel device for cryobiopsy of the upper urinary tract (UUT) and to evaluate its feasibility in a standardized preclinical setting. MATERIALS AND METHODS Flexible cryoprobes (diameter 0.9 mm; cooling agent CO2) were developed and used to extract biopsies in porcine UUTs. Cryosamples obtained by ureterorenoscopy were systematically compared with biopsy specimens obtained with standard of care devices in terms of physical characteristics (deflection angle and irrigation flow rates) and histologic criteria (assessability). RESULTS Irrigation flow rates were significantly higher with introduced BIGopsy (2.8 ± 0.1) compared with standard forceps (0.94 ± 0.06; P < .001) and cryoprobe (1.1 ± 0.1; P < .001). Angular deflection was significantly reduced by the inserted cryoprobe (130.7° ± 1.2° vs 166.9° ± 1.1° [BIGopsy] or 161.4° ± 1.9° [standard forceps]; both P < .001). Significantly larger UUT tissue samples were obtained by the cryoprobe (mean specimen area 7.5 ± 2.5 vs 4.6 ± 2.5 mm² [BIGopsy] or 1.4 ± 1.4 mm² [standard forceps]; both P < .001). No crush artifacts were observed in cryosamples. Superior histologic assessability scores were achieved in samples obtained by the cryoprobe (mean 2.8 ± 0.8) and BIGopsy (2.3 ± 1.9) when compared with standard forceps (0.4 ± 0.9; P < .001). CONCLUSION Cryobiopsy in the UUT is feasible and represents a viable new option to improve the diagnostic accuracy of histopathologic evaluation. Larger and more representative tissue samples can be obtained using a cryoprobe and artifacts may be avoided. Further optimization of the probe will reduce possible restrictions of ureterorenoscopy handling when the device is inserted.
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Affiliation(s)
| | | | | | | | | | - Hans Bösmüller
- Institute of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany
| | - Jens Mundhenk
- Department of Urology, Diakonie Hospital, Stuttgart, Germany
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