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Yazici CM, Cakir H, Ozman O, Basatac C, Akgul HM, Cinar O, Siddikoglu D, Sancak EB, Baseskioglu B, Keles A, Onal B, Akpinar H. The Effect of Reusable Flexible Ureteroscope Aging on the Efficacy and Safety of Retrograde Intrarenal Surgery. J Laparoendosc Adv Surg Tech A 2024; 34:628-632. [PMID: 38716805 DOI: 10.1089/lap.2024.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2024] Open
Abstract
Purpose: Reusable flexible ureteroscopes may lose their mechanical functionality through overuse, which is known as "aging of the flexible ureteroscope." Although mechanical deterioration has been shown in several studies, the data about the effect of this situation on the efficacy and safety of retrograde intrarenal surgery (RIRS) are missing. The aim of our study was to evaluate the effect of the aging of flexible ureteroscopes on the efficacy and safety of RIRS. Methods: Patients who had undergone RIRS between 2017 and 2021 at a single center were retrospectively included in the study. Serial surgeries were performed using the same reusable flexible ureteroscope (Storz X2) until it was broken or malfunctioned because of the aging process. Group 1 was formed by the first 10 cases on whom the flexible ureteroscopes were used, representing the youngest period of the instruments, whereas group 2 was composed of the last 10 cases on whom the flexible ureteroscopes were used, representing the oldest phase of the instruments. The operative and postoperative data-including the operation time, hospitalization time, intraoperative complications, postoperative complications, and stone-free rates-were compared between the two groups. Results: A total of five flexible ureteroscopes were included in the study. The number of cases for each flexible ureteroscope ranged between 87 and 133, with a median number of 107 cases. The demographic and clinical properties of patients in both groups were similar. The operation time, lasering time, and total laser pulse were similar between the groups. The stone-free rates in group 1 and group 2 were 82.0% and 78.0%, respectively (p = 0.304). The complication rates were also similar between the groups (p = 0.591). Conclusion: The aging of reusable flexible ureteroscopes did not negatively affect the efficacy and safety of RIRS. Therefore, surgeons may use the reusable types of flexible ureteroscopes until they are totally broken.
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Affiliation(s)
- Cenk Murat Yazici
- Department of Urology, Tekirdag Namik Kemal University School of Medicine, Tekirdag, Turkey
| | - Hakan Cakir
- Clinic of Urology, Acibadem Fulya Hospital, Istanbul, Turkey
| | - Oktay Ozman
- Clinic of Urology, Memorial Bahçelievler Hospital, Istanbul, Turkey
| | - Cem Basatac
- Clinic of Urology, Group Florence Nightingale Hospitals, Istanbul, Turkey
| | - Haci Murat Akgul
- Department of Urology, Tekirdag Namik Kemal University School of Medicine, Tekirdag, Turkey
| | - Onder Cinar
- Clinic of Urology, Medicana International Samsun Hospital, Samsun, Turkey
| | - Duygu Siddikoglu
- Department of Biostatistics, Canakkale Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Eyup Burak Sancak
- Department of Urology, Canakkale Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | | | - Anil Keles
- Department of Urology, Tekirdag Namik Kemal University School of Medicine, Tekirdag, Turkey
| | - Bulent Onal
- Department of Urology, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Haluk Akpinar
- Clinic of Urology, Group Florence Nightingale Hospitals, Istanbul, Turkey
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Kwok JL, De Coninck V, Panthier F, Kamkoum H, Pauchard F, Shrestha A, Gauhar V, Brachlow J, Schmid FA, Poyet C, Eberli D, Traxer O, Keller EX. Illumination matters part IV: blackout and whiteout in flexible ureteroscopy - first report on a phenomenon observed by PEARLS. World J Urol 2024; 42:294. [PMID: 38704777 PMCID: PMC11070394 DOI: 10.1007/s00345-024-04988-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/07/2024] [Indexed: 05/07/2024] Open
Abstract
PURPOSE To date, no study has evaluated effects of varying brightness settings on image quality from flexible ureteroscopes submerged in saline. The aim was to evaluate blackout and whiteout occurrences in an in-vitro kidney calyx model. MATERIAL AND METHODS We evaluated a series of contemporary flexible ureteroscopes including the Storz Flex-Xc and Flex-X2s, Olympus V3 and P7, Pusen 7.5F and 9.2F, as well as OTU WiScope using a 3D-printed enclosed pink in-vitro kidney calyx model submerged in saline. Endoscopic images were captured with ureteroscope tip placed at 5 mm,10 mm and 20 mm distances. The complete range of brightness settings and video capture modes were evaluated for each scope. Distribution of brightness on a grayscale histogram of images was analyzed (scale range 0 to 255). Blackout and whiteout were defined as median histogram ranges from 0 to 35 and 220 to 255, respectively (monitor image too dark or too bright for the human eye, respectively). RESULTS Blackout occurred with the P7, Pusen 7.5F, 9.2F and WiScope at all distances, and V3 at 20 mm - with lowest brightness settings. Whiteout occurred with Flex-X2s, V3 and P7 at 5 mm and 10 mm, as well as with V3 and P7 at 20 mm - mostly with highest brightness settings. The Flex-Xc had neither blackout nor whiteout at all settings and distances. CONCLUSION Blackout or whiteout of images is an undesirable property that was found for several scopes, possibly impacting diagnostic and therapeutic purposes during ureteroscopy. These observations form a guide to impact a urologist's choice of instruments and settings.
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Affiliation(s)
- Jia-Lun Kwok
- Department of Urology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vincent De Coninck
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Frédéric Panthier
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC N°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Hatem Kamkoum
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Hamad Medical Corporation, Doha, Qatar
| | - Felipe Pauchard
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Urology Department, Hospital Naval Almirante Nef, 2520000, Viña del Mar, Chile
| | - Anil Shrestha
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, National Academy of Medical Sciences, Bir Hospital and B&B Hospital, Gwarko Lalitpur, Nepal
| | - Vineet Gauhar
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Jan Brachlow
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Zentrum Für Urologie Winterthur, Winterthur, Switzerland
| | - Florian Alexander Schmid
- Department of Urology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
| | - Olivier Traxer
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC N°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France.
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands.
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Belkovsky M, Passerotti CC, Maia RS, de Almeida Artifon EL, Otoch JP, Da Cruz JAS. Comparing outcomes of single-use vs reusable ureteroscopes: a systematic review and meta analysis. Urolithiasis 2024; 52:37. [PMID: 38413490 DOI: 10.1007/s00240-024-01537-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 01/28/2024] [Indexed: 02/29/2024]
Abstract
Flexible ureterolithotripsy is a frequent urological procedure, usually used to remove stones from the kidney and upper ureter. Reusable uretero-scopes were the standard tool for that procedure, but recent concerns related to sterility and maintenance and repair costs created the opportunity to develop new technologies. In 2016, the first single-use digital flexible ureteroscope was introduced. Since then, other single-use ureteroscopes were developed, and studies compared them with the reusable ureteroscopes with conflicting results. The purpose of this study is to describe the literature that compares the performance of single-use and reusable flexible ureteroscopes in retrograde intrarenal surgery for urinary stones. A Systematic Review was performed in October 2022 in accordance with the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA). A search in MEDLINE, EMBASE, Web of Science, Google Scholar and LILACS retrieved 10,039 articles. After screening, 12 articles were selected for the Meta-Analysis. No differences were found in stone-free rate (OR 1.31, CI 95% [0.88, 1.97]), operative time (MD 0.12, CI 95% [-5.52, 5.76]), incidence of post-operative fever (OR 0.64, CI 95% [0.22, 1.89]), or incidence of post-operative urinary tract infection (OR 0.63 CI 95% [0.30, 1.32]). No differences were observed in the studied variables. Hence, the device choice should rely on the availability, cost analysis and surgeons' preference.
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Affiliation(s)
- Mikhael Belkovsky
- Surgical Technique & Experimental Surgery Department, Universidade de São Paulo, São Paulo, Brazil
| | | | - Ronaldo Soares Maia
- Surgical Technique & Experimental Surgery Department, Universidade de São Paulo, São Paulo, Brazil
| | | | - José Pinhata Otoch
- Surgical Technique & Experimental Surgery Department, Universidade de São Paulo, São Paulo, Brazil
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Özman O, Başataç C, Akgül M, Çakır H, Çınar Ö, Şimşekoğlu F, Yazıcı CM, Sancak EB, Baseskioglu B, Akpınar H, Önal B. The Effect of Ureteral Access Sheath Use/Caliber Change on Outcomes of Retrograde Intrarenal Surgery, Short-Term Kidney Functions, Radiation Exposure, Ureteroscope Lifetime, and Factors Predicting Insertion Failure: A RIRSearch Study. J Laparoendosc Adv Surg Tech A 2024; 34:33-38. [PMID: 37948549 DOI: 10.1089/lap.2023.0358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Background: The aim of this study was (1) to explore effect of ureteral access sheath (UAS) use on primary retrograde intrarenal surgery (RIRS) outcomes, short-term kidney functions, radiation exposure, and ureteroscope lifetime (URS-LT) and (2) to reveal factors that predict UAS insertion failure. Materials and Methods: Patients (n = 1318) who underwent RIRS without UAS (Group 1), those who had operation with a <11-13 Fr (Group 2), and those with a ≥11-13 Fr UAS were matched (1:1:2) and compared. Stone-free rate (SFR), intra- and postoperative complications, acute kidney injury (AKI), fluoroscopy time, URS-LT, and UAS insertion failure were the outcomes. Results: SFR, which was highest in Group 3 (75%, 71% and 87.3%, respectively; P = .001), was significantly associated with use of ≥11-13 Fr (odds ratio [OR]: 4.2, P < .001), but was not with use of <11-13 Fr UAS (OR: 1.3, P = .3). Group 3 had less need for auxiliary procedure (15%, 16%, and 7.4%, respectively; P = .03). Five percent of patients had a risk of AKI, but only 0.3% developed AKI. Although UAS use was protective against creatinine increase (OR: 0.65, P = .02), increased risk of AKI was only associated with female gender (OR: 5.5, P < .001). Fluroscopy times were 5, 15, and 87 sn, respectively (P < .001). Short URS-LT was strongly associated with high frequency of lower calix stones (r = -0.94, P = .005), but URS-LT was not correlated with sheathless case rate (r = 0.59, P = .22). UAS insertion success in first attempt was more likely in younger (OR: 0.99, P = .03), hydronephrotic (OR: 3.4, P < .001), and female cases (OR: 1.5, P = .008). But absolute UAS insertion failure was associated with female gender (OR: 2.7, P = .017). Conclusions: Not any UAS use but a higher caliber UAS use may improve SFR and protect against AKI after RIRS. Although UAS insertion failure is seen mostly in men, it may be more challenging in women owing to less efficacy of preoperative Double-J stent.
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Affiliation(s)
- Oktay Özman
- Department of Urology, The Netherlands Cancer Institute (NKI), Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Cem Başataç
- Department of Urology, Group Florence Nightingale Hospitals, İstanbul, Turkey
| | - Murat Akgül
- Department of Urology, School of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Hakan Çakır
- Department of Urology, Fulya Acıbadem Hospital, Urology Clinic, İstanbul, Turkey
| | - Önder Çınar
- Department of Urology, Samsun Medicana Hospital, Urology Clinic, Samsun, Turkey
| | - Fatih Şimşekoğlu
- Department of Urology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Cenk Murat Yazıcı
- Department of Urology, School of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Eyüp Burak Sancak
- Department of Urology, School of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Barbaros Baseskioglu
- Department of Urology, Eskişehir Acıbadem Hospital, Urology Clinic, Eskişehir, Turkey
| | - Haluk Akpınar
- Department of Urology, Group Florence Nightingale Hospitals, İstanbul, Turkey
| | - Bülent Önal
- Department of Urology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
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5
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Shrestha A, Adhikari B, Panthier F, Baidya S, Gauhar V, Traxer O. Flexible ureteroscopy for lower pole calculus: is it still a challenge? World J Urol 2023; 41:3345-3353. [PMID: 37728745 DOI: 10.1007/s00345-023-04606-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE Flexible ureteroscopy (fURS) is steadily gaining popularity in the management of renal calculi, including those located in the lower pole (LP). Due to difficulty in accessing to the LP of kidney in minority of cases with fURS and reports of lower stone-free rate (SFR), it is still considered as a challenge in selected cases. The purpose of the review was to analyze the various aspects of fURS for LP stones. METHODS An extensive review of the recent literature was done including different factors such as anatomy, preoperative stenting, stone size, flexible scopes, types of lasers, laser fibers, suction, relocation, stone-free rates, and complications. RESULTS The significance of various lower pole anatomical measurements remain a subject of debate and requires standardization. Recent improvements in fURS such as single-use digital scopes with better vision and flexibility, high power laser, thulium fiber laser, smaller laser fiber, and accessories have significantly contributed to make flexible ureteroscopy more effective and safer in the management of LP stone. The utilization of thulium fiber lasers in conjunction with various suction devices is being recognized and can significantly improve SFR. CONCLUSIONS With the significant advancement of various aspects of fURS, this treatment modality has shown remarkable efficacy and gaining widespread acceptance in management of LP kidney stones. These developments have made the fURS of LP stones less challenging.
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Affiliation(s)
- Anil Shrestha
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
- B&B Hospital, Lalitpur, Nepal.
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Chen TT, Nguyen MV, Cerrato C, Berger JH, Vartanian KB, Gerrity JJ, Sur RL, Bechis SK, Monga M. Clinical Evaluation of Miniature Flexible Scope for Diagnosis of Ureteroscope Working Channel Defects. J Endourol 2023; 37:628-633. [PMID: 36974366 DOI: 10.1089/end.2022.0642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Introduction: To evaluate flexible ureteroscope working channels with a 1.06 mm digital borescope (Clarus Medical, Minneapolis, MN) and identify factors contributing to ureteroscope damage over time. Materials and Methods: We performed a single institutional prospective study of patients undergoing stone surgery using a nondisposable flexible ureteroscope. A 1.06 mm borescope was used to evaluate ureteroscopes before and after surgery. Borescope videos were reviewed by two independent researchers to quantify average pre- and postprocedural damage. Results: Twenty-five procedures were performed with pre- and postprocedural borescope assessment between August 2021 and February 2022. All patients received preoperative CT imaging depicting a mean axial stone size of 14.1 ± 8.4 mm and density of 923.4 ± 458.1 HU. Mean operative time was 63.8 ± 34.0 minutes. The average number an instrument passes through the working channel was 2.1 ± 1.6. Laser was used in 11 cases with mean laser time of 18.8 ± 19.7 minutes and mean total energy of 5.8 ± 4.2 KJ. On preoperative assessment, all ureteroscopes had some form of defect (24% shave, 32% pinhole, 96% dents and scratches, and 28% discolorations). During postoperative assessment, 23/25 (92%) ureteroscopes showed additional damage with an average of 3.7 ± 2.8 imperfections acquired after one use. Significant differences were seen in acquired shavings (p = 0.028) and scratches or dents (p = 0.018). Of the 355 imperfections seen on postoperative evaluation, 0.4% were shave, 3% were pinhole, 85.8% were dents and scratches, and 10.8% were discolorations. Conclusion: The Clarus borescope observed defects after the majority of flexible ureteroscopy procedures for nephrolithiasis. Although such disruptions may not immediately render ureteroscopes nonfunctional, they are more common than previously described and could increase maintenance costs. Further studies are needed to investigate the burden of unit damage per procedure to raise operator awareness and reduce preventable ureteroscope imperfections.
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Affiliation(s)
- Tony T Chen
- Department of Urology, University of California San Diego, San Diego, California, USA
| | - Mimi V Nguyen
- University of California San Diego, San Diego, California, USA
| | - Clara Cerrato
- Department of Urology, University of California San Diego, San Diego, California, USA
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Jonathan H Berger
- Department of Urology, University of California San Diego, San Diego, California, USA
| | | | | | - Roger L Sur
- Department of Urology, University of California San Diego, San Diego, California, USA
| | - Seth K Bechis
- Department of Urology, University of California San Diego, San Diego, California, USA
| | - Manoj Monga
- Department of Urology, University of California San Diego, San Diego, California, USA
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7
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Jun DY, Cho KS, Jeong JY, Moon YJ, Kang DH, Jung HD, Lee JY. Comparison of Surgical Outcomes between Single-Use and Reusable Flexible Ureteroscopes for Renal Stone Management: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1388. [PMID: 36295549 PMCID: PMC9607009 DOI: 10.3390/medicina58101388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 10/03/2023]
Abstract
Background and Objectives: Disposable flexible ureteroscopes have been widely used because of their cost-effectiveness and higher sterility potential compared with reusable flexible ureteroscopes. This study aimed to compare the surgical outcomes and complication rates in patients who undergo reusable or disposable flexible ureteroscopic stone surgeries (fURS) for urinary stone disease. Materials and Methods: A systematic review and meta-analysis were conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. This systematic review was registered with PROSPERO (CRD42022331291). Clinical trials comparing reusable and disposable fURS for stone disease were found from PubMed, EMBASE, Cochrane Library, and the Web of Science up to March 2022. Participants were patients with upper urinary tract stones; the interventions were reusable or disposable fURS. Outcomes, including stone-free rate, operation time, length of hospital stay, and complication rate, were compared for analysis. Results: Overall, 111 studies were identified, but after removing duplicate studies, 75 studies remained. Thirty-two of these studies were excluded. Of the 43 screened studies, 11 met the eligibility criteria. There was no difference in the stone-free rate (SFR) between disposable and reusable fURS (p = 0.14; OR = 1.36; 95% CI, 0.9 to 2.04). For operation time, no difference was identified between reusable and disposable fURS groups (p = 0.12; MD = -5.31; 95% CI, -12.08 to 1.46). For hospital stay, there was also no difference between the two groups (p = 0.61; MD = -0.03; 95% CI, -0.17 to 0.10). There was no significant difference in complication rate between the two groups (p = 0.85; OR = 0.95; 95% CI, 0.56 to 1.61). Conclusions: There were no differences in the SFR, operation time, length of hospital stay, and complication rate between reusable and disposable fURS. Disposable fURS may be a comparable alternative to reusable fURS.
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Affiliation(s)
- Dae Young Jun
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Kang Su Cho
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Jae Yong Jeong
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Young Joon Moon
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Dong Hyuk Kang
- Department of Urology, Inha University College of Medicine, Incheon 22212, Korea
| | - Hae Do Jung
- Department of Urology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul 03722, Korea
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Entezari P, Soliman M, Malik A, Moazeni Y, Reiland A, Thornburg B, Rajeswaran S, Salem R, Srinivasa R, Riaz A. How Endoscopic Guidance Augments Nonvascular Image-guided Interventions. Radiographics 2022; 42:1845-1860. [DOI: 10.1148/rg.220013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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9
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Ali AI, Eldakhakhny A, Abdelfadel A, Rohiem MF, Elbadry M, Hassan A. WiScope® single use digital flexible ureteroscope versus reusable flexible ureteroscope for management of renal stones: a prospective randomized study. World J Urol 2022; 40:2323-2330. [PMID: 35895116 DOI: 10.1007/s00345-022-04095-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/07/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To compare the clinical performance and surgical outcomes of the new digital single use flexible ureteroscope (WiScope®) with a reusable digital flexible ureteroscope. PATIENT AND METHODS Our prospective study includes patients with renal stones less than 2 cm who underwent retrograde flexible ureteroscopy and laser lithotripsy. Patients were randomized into two groups: group A included patients who underwent laser lithotripsy using WiScope® Single use digital flexible ureteroscope and group B included patients who underwent laser lithotripsy using reusable flexible ureteroscope. Image quality, deflection, ease of insertion, maneuverability, and overall performance were assessed using either a visual analog or Likert scale. Operative outcomes and complications were collected and analyzed in both groups. RESULTS A total of 242 patients were included in our study. There were 121 patients in the WiScope® group and 121 patients in reusable ureteroscope group. The WiScope® had higher maneuverability (9.3 ± 0.7 vs. 7.2 ± 0.8, P < 0.001) and less limb fatigue but had lower image quality when compared to reusable digital flexible ureteroscope (7.6 ± 0.9 vs. 9.2 ± 0.6, P < 0.001). There were no differences in operative time, complication rates and rates of relook ureteroscopy. CONCLUSIONS The WiScope® single use flexible ureteroscope has comparable outcomes to the reusable flexible ureteroscope with regard to maneuverability, limb fatigue, and deflection. However, it has a lower image quality.
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Affiliation(s)
- Ahmed I Ali
- Department of Urology, School of Medicine, Minia University Hospital, Minia, 61111, Egypt.
| | - Amr Eldakhakhny
- Department of Urology, School of Medicine, Benha University Hospital, Benha, 61111, Egypt
| | - Abdelsalam Abdelfadel
- Department of Urology, School of Medicine, Minia University Hospital, Minia, 61111, Egypt
| | - Mahmoud F Rohiem
- Department of Urology, Port Said University Hospital, Port Said, 6459, Egypt
| | - Mohamed Elbadry
- Department of Urology, School of Medicine, Minia University Hospital, Minia, 61111, Egypt
| | - Ali Hassan
- Department of Urology, School of Medicine, Minia University Hospital, Minia, 61111, Egypt
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Ofstead CL, Hopkins KM, Smart AG, Eiland JE, Wetzler HP, Bechis SK. Reprocessing effectiveness for flexible ureteroscopes: A critical look at the evidence. Urology 2022; 164:25-32. [DOI: 10.1016/j.urology.2022.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/12/2022] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
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11
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Single-Use Versus Reusable Endoscopes for Percutaneous Biliary Endoscopy with Lithotripsy: Technical Metrics, Clinical Outcomes, and Cost Comparison. J Vasc Interv Radiol 2021; 33:420-426. [PMID: 34958859 DOI: 10.1016/j.jvir.2021.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/06/2021] [Accepted: 12/16/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare procedure and fluoroscopy time, technical and clinical success, and costs between single-use and reusable endoscopes in patients undergoing percutaneous biliary endoscopy (PBE) with lithotripsy. MATERIAL AND METHODS In this retrospective study, we included 34 patients (67 procedures) treated with PBE for gallstone removal from October 24, 2014, through February 12, 2020, using reusable (28 procedures) or single-use (39 procedures) endoscopes. We compared 1) procedure time, 2) fluoroscopy time, 3) technical success rate (accessing the biliary system and locating the gallstone), 4) clinical success rate (at least partial gallstone removal), 5) complication rate, and 6) cost of use. Alpha = 0.05. RESULTS Mean (± standard deviation) procedure time was not significantly different between single-use (136 ± 45 minutes) and reusable endoscopes (136 ± 51 minutes) (p = 0.47). Mean fluoroscopy time was significantly shorter for single-use endoscopes (11 ± 8.4 minutes) than for reusable endoscopes (18 ± 12 minutes) (p = 0.01). When comparing single-use vs. reusable endoscopes, rates were not significantly different for technical success (N=37, 95% vs. N=26, 93%) or clinical success (N=35, 90% vs. N=21, 75%) (both, p>0.05). Only 1 complication was noted in the reusable endoscope group (p=0.42). Cost per case was lower for single-use ($1500) than for reusable ($3987) endoscope procedures, primarily due to differences in capital costs and costs due to repair. CONCLUSION Single-use endoscopes offer the potential for less radiation exposure to the patient and lower cost per case, which may reduce financial barriers to offering PBE in interventional radiology practices. Clinical and technical success rates did not differ by endoscope type.
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12
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Domenech A, Alliende C, Vivaldi B, Pizzi P. Comparison of pre- and post-surgical images of reusable and single use flexible ureteroscopes: a qualitative analysis. Cent European J Urol 2021; 74:459-463. [PMID: 34729238 PMCID: PMC8552943 DOI: 10.5173/ceju.2021.0032.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/05/2021] [Accepted: 07/10/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Given the fragility of reusable ureterorenoscopes, many single use instruments have appeared on the market. Unfortunately, reuse of these scopes occurs in undeveloped countries in order to cut costs. This raises safety concerns for the patient. The aim of this article was to macroscopically evaluate the changes that single use flexible ureterorenoscopes (su-fURS) suffer after a retrograde intrarenal surgery (RIRS), and to compare them to reusable fURS. Material and methods Pre and post-operative images of the instruments used in 23 RIRS were obtained. All the cases had renal calculi of the inferior calix between 10–15 mm, and all of them were treated with Holmium laser. The ureterorenoscopes used were: Storz® Flex X2, Storz® Flex XC, Pusen® 3022, OTU® Wiscope, AnQIng® Innovex and Boston Scientific® LithoVue. Qualitative comparisons of these were made. Results After su-fURS usage, significant damage was observed, especially on the distal tip. Deflection was not compromised. Reusable fURS did not sustain any damage after their use. Conclusions fURS are delicate equipment, especially if they are of single use. The considerable damage sustained by single use scopes could mean that reuse of these instruments is dangerous and should be avoided.
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Affiliation(s)
- Alfredo Domenech
- Department of Urology, Clínica RedSalud Vitacura, Santiago, Chile.,Department of Urology, Univesidad de los Andes, Santiago, Chile
| | | | - Bruno Vivaldi
- Department of Urology, Clínica RedSalud Vitacura, Santiago, Chile.,Department of Urology, Univesidad de los Andes, Santiago, Chile
| | - Pablo Pizzi
- Department of Urology, Clínica RedSalud Vitacura, Santiago, Chile
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Mourmouris P, Tzelves L, Raptidis G, Berdempes M, Markopoulos T, Dellis G, Siafakas I, Skolarikos A. Comparison of a single-use, digital flexible ureteroscope with a reusable, fiberoptic ureteroscope for management of patients with urolithiasis. Arch Ital Urol Androl 2021; 93:326-329. [PMID: 34839639 DOI: 10.4081/aiua.2021.3.326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 07/25/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES 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. PATIENTS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Panagiotis Mourmouris
- National and Kapodistrian University of Athens, 2nd University Department of Urology, Sismanoglio Hospital, Athens.
| | - Lazaros Tzelves
- National and Kapodistrian University of Athens, 2nd University Department of Urology, Sismanoglio Hospital, Athens.
| | | | - Marinos Berdempes
- National and Kapodistrian University of Athens, 2nd University Department of Urology, Sismanoglio Hospital, Athens.
| | - Titos Markopoulos
- National and Kapodistrian University of Athens, 2nd University Department of Urology, Sismanoglio Hospital, Athens.
| | | | | | - Andreas Skolarikos
- National and Kapodistrian University of Athens, 2nd University Department of Urology, Sismanoglio Hospital, Athens.
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Göger YE, Özkent MS, Kılınç MT, Taşkapu HH, Göger E, Aydın A, Sönmez MG, Karalezli G. Efficiency of retrograde intrarenal surgery in lower pole stones: disposable flexible ureterorenoscope or reusable flexible ureterorenoscope? World J Urol 2021; 39:3643-3650. [PMID: 33738574 DOI: 10.1007/s00345-021-03656-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/06/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The primary aim of this study to comparison of reusable and disposable flexible ureterorenoscope (fURS) efficiency in lower pole renal stone disease management. In addition, the secondary goal of this study was to evaluate the factors affecting stone-free rates (SFR) in lower pole stones. MATERIALS AND METHODS A prospective case-control study utilizing data from 122 consecutive ureteroscopic cases. The patients were divided into two groups according to the ureterorenoscope employed in the surgical intervention as disposable fURS (Group1, n:52) and reusable fURS (Group 2, n:70). Demographic characteristics, stone size, infundibulopelvic angle (IPA), SFR, hospitalization time, intraoperative complication rate (CR), operative time, preoperative or postoperative JJ stenting, and postoperative CR were analyzed. RESULTS There was no statistical difference between the demographic and renal stone-related data between the groups. Likewise, no difference is observed in term of intraoperative and postoperative outcomes such as fluoroscopy time, CR, and hospitalization time between the groups. Although SFR was higher in the disposable fURS group, there was no difference statistically. However, the operative time was longer in reusable fURS Group (47.02 ± 9.91 min in Group 1, and it was 57.97 ± 14.28 in Group 2) (p: 0.001). The multivariate regression analysis result to evaluate the factors of effect to operative time; the use of disposable fURS was associated with a 10.95-min decrease in procedure duration (p < 0.001). CONCLUSIONS Disposable fURS and reusable fURS have similar clinical efficiency and complication rates in the treatment of lower calyceal stones with RIRS. Nevertheless, disposable fURS is a useful treatment option for increased stone volume due to the advantages such as shorter operative time.
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Affiliation(s)
- Yunus Emre Göger
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Serkan Özkent
- Department of Urology, Konya Education and Research Hospital, Health Sciences University, Ayanbey quarter, Yeni Meram Street, Number: 97, 42090, Konya, Turkey.
| | - Muzaffer Tansel Kılınç
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Hakan Hakkı Taşkapu
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Esra Göger
- Department of Anesthesia, Konya Education and Research Hospital, Health Sciences University, Konya, Turkey
| | - Arif Aydın
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Giray Sönmez
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Giray Karalezli
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
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15
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Carlier M, Baboudjian M, Govidin L, Yahia M, Chiappini J, Lechevallier E, Boissier R. [Single-use versus reusable flexible ureteroscope: Technical and medico-economic aspects]. Prog Urol 2021; 31:937-942. [PMID: 34456138 DOI: 10.1016/j.purol.2021.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Sate of the art on the indications, methods of implementation and medico-economic considerations of reusable flexible ureteroscopes (URSr) vs single use (URSuu)? METHOD Review of the literature (Pubmed) on reusable and single-use ureteroscopes, as well as on the expertise of our center. A PubMed search and narrative review of the data was performed in July 2021. Only articles in French or English were selected. RESULTS The URSr and URSuu have similar technical characteristics and are suitable for the exploration of the upper urinary excretory tract: treatment of stones of the kidney <2cm or of the ureter. The URSr is the most common type of ureteroscope. URSuu are newer and associated with many advantages: no sterilization procedure, immediate availability of equipment in the operating room, reduced waste production at the institutional level. A hybrid use of URSr and URSuu currently seems to be the best compromise from a medico-economic point of view for high volume centers. In the case of a smaller activity or a secondary site, URSuu are more advantageous and the reduction in purchasing costs should accentuate this benefit. CONCLUSION URSr and URSuu are technically similar and allow identical treatment of upper urinary tract pathologies. Their complementary use optimizes the care of urology patients. The barrier to the exclusive use of URSuu remains their cost.
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Affiliation(s)
- M Carlier
- Aix-Marseille université, service d'urologie et de transplantation rénale, CHU La Conception, AP-HM, Marseille, France
| | - M Baboudjian
- Aix-Marseille université, service d'urologie et de transplantation rénale, CHU La Conception, AP-HM, Marseille, France
| | - L Govidin
- Aix-Marseille université, service d'urologie et de transplantation rénale, CHU La Conception, AP-HM, Marseille, France
| | - M Yahia
- Aix-Marseille université, service d'urologie et de transplantation rénale, CHU La Conception, AP-HM, Marseille, France
| | - J Chiappini
- Aix-Marseille université, service d'urologie et de transplantation rénale, CHU La Conception, AP-HM, Marseille, France
| | - E Lechevallier
- Aix-Marseille université, service d'urologie et de transplantation rénale, CHU La Conception, AP-HM, Marseille, France
| | - R Boissier
- Aix-Marseille université, service d'urologie et de transplantation rénale, CHU La Conception, AP-HM, Marseille, France.
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16
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Can the introduction of single-use flexible ureteroscopes increase the longevity of reusable flexible ureteroscopes at a high volume centre? World J Urol 2021; 40:251-256. [PMID: 34424373 DOI: 10.1007/s00345-021-03808-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To assess whether the introduction of single use flexibles ureteroscopes (su-fURS) at our high-volume centre had an advantageous impact on the turn-over and breakage rates of reusable fURS (re-fURS). METHODS We analysed re-fURS number of usages and breakages at our centre between February 2015 and December 2018. We recorded the number of usages for analysed scope between the first usage until a breakage requiring reconditioning. Usage count was restarted following each reconditioning episode. Since su-fURS (Lithovue, Boston Scientific, USA) were introduced at our center in September 2016, we had the chance to compare different re-fURS life cycles according to both su-fURS availability and usage intensity (i.e., number of su-fURS used during each re-fURS life cycle). We then explored the relationship between su-fURS usage intensity and reusable scope survival (i.e., number of utilizations before any breakage requiring reconditioning) using locally weighted scatterplot smoothing (LOWESS) approach. RESULTS Five different re-fURSs were employed at our centre, for a total of 1820 usages and 40 breakages requiring reconditioning. The overall mean (SD) number of usages before breaking was 40 (22). After su-fURS introduction, mean (SD) re-fURS number of usages increased from 35 (22) to 49 (20), (+ 40%, p = 0.02). The relationship between su-fURS usage intensity and reusable scopes survival showed a linear survival increase after 10 or more su-fURS scopes were used per life cycle. CONCLUSIONS The life cycle of re-fURS increased by 40% after the introduction of su-fURS. Ten or more used su-fURS per life cycle were associated with increased re-fURS survival.
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17
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Hendriks N, Henderickx MMEL, Schout BMA, Baard J, van Etten-Jamaludin FS, Beerlage HP, Pelger RCM, Kamphuis GM. How to evaluate a flexible ureterorenoscope? Systematic mapping of existing evaluation methods. BJU Int 2021; 128:408-423. [PMID: 34242475 PMCID: PMC8519042 DOI: 10.1111/bju.15544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/25/2021] [Accepted: 07/02/2021] [Indexed: 01/01/2023]
Abstract
Objectives The objective of this study was to identify, map and review scope‐related and user‐related parameters used to evaluate the quality of flexible ureterorenoscopes. Thereby identifying key items and variability in grading systems. Methods A literature search of four databases (MEDLINE [Ovid], EMBASE [Ovid], Web of Science, Google scholar and the Cochrane Library) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines encompassing articles published up to August 2020. A total of 2386 articles were screened. Results A total of 48 articles were included in this systematic scoping review. All studies had a prospective design. Five key items in the assessment of flexible ureterorenoscopy were distinguished: ‘Manoeuvrability’ (87.5%), ‘Optics’ (64.6%), ‘Irrigation’ (56.3%), ‘Handling’ (39.6%) and ‘Durability’ (35.4%). After regrouping, every key item could be divided into specific subcategories. However, the quality assessment showed a wide variation in denomination, method of measurement, circumstances of measurement, tools used during measurements, number of measurements performed, number of observers, and units of outcomes. Conclusion The research field regarding quality assessment of ureterorenoscopes is heterogeneous. In this systematic scoping review we identified five key parameters: Manoeuvrability, Optics, Irrigation, Handling and Durability, used to grade flexible ureterorenoscopes. However, within these categories we found a wide variety in terms of method of measurements. A standardised, uniform grading tool is required to assess and compare the quality of flexible ureterorenoscopes in the future.
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Affiliation(s)
- Nora Hendriks
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Urology, Alrijne Hospital, Leiderdorp, the Netherlands
| | - Michaël M E L Henderickx
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Urology, GZA Hospitals, Antwerp, Belgium
| | | | - Joyce Baard
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Faridi S van Etten-Jamaludin
- Research Support, Medical library location AMC, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Harrie P Beerlage
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Rob C M Pelger
- Department of Urology, Leids UMC, University of Leiden, Leiden, the Netherlands
| | - Guido M Kamphuis
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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18
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Afyouni AS, O'Leary M, Okhunov Z, Ayad M, Yoon R, Brevik A, Peta A, Patel RM, Dolan B, Landman J, Clayman R. Global Assessments of the Endockscope System: Long-Term Impact of Cyber Endoscopy. J Endourol 2021; 35:1684-1692. [PMID: 33926236 DOI: 10.1089/end.2020.1228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The disproportionate costs of state-of-the-art endoscopic equipment prohibit urologists from performing endoscopy in underserved countries. Given the global prevalence of smartphones, we engineered a $45 alternative endoscope utilizing three-dimensional (3D) printed attachments, an 8x lens, and a 1,000-lumen light-emitting diode (LED) cordless flashlight (Endockscope System (ES)). MATERIALS AND METHODS At the 34th World Congress of Endourology in Cape Town, South Africa (WCE 2016; 4-year group) and at the 39th Congress of the Société Internationale d'Urologie in Athens, Greece (SIU 2019; 8-month group), a total of 40 ES kits were distributed free of charge to an international group of urologists. Participants were given instructions and a hands-on demonstration of the device. Urologists given an ES were subsequently asked to complete a survey between June and September 2020 which included questions regarding user satisfaction, comfort, and comparability of the ES to standard endoscopic systems. RESULTS Urologists from 23 countries received ES kits. Overall, 10 of 22 urologists (10/22; 45%) from the 4-year group and 18 of 18 urologists (18/18; 100%) from the 8-month group completed the survey. The ES device was used by 80% (8/10) and 83% (15/18) of urologists from the 4-year and the 8-month groups, respectively. Of note, the greatest impact of ES usage was among urologists from the most impoverished countries. Of those who used the ES, 44% (4/9) of urologists from the 4-year cohort and 47% (8/17) from the 8-month cohort reported they were able to perform more endoscopic procedures directly because of the ES. Moreover, 57% (4/7) of the 4-year participants and 67% (10/15) of the 8-month participants found the ES equal or superior in quality to their standard endoscopic equipment. CONCLUSION The ES provided an effective and inexpensive system that enabled urologists in resource-challenged countries to successfully perform and expand their use of urological endoscopy.
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Affiliation(s)
- Andrew Shea Afyouni
- University of California Irvine, 8788, Department of Urology, 333 City Blvd W, Orange, California, United States, 92868;
| | - Mitchell O'Leary
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Zhamshid Okhunov
- University of California Irvine, 8788, Urology, Orange, California, United States.,Uro-technology Working Group of the Young Academic Urologists Working Party of the European Association of Urology, Arnhem, Netherlands;
| | - Maged Ayad
- University of California Irvine, 8788, Urology, 101 The City Drive S, Orange, California, United States, 92868;
| | - Renai Yoon
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Andrew Brevik
- University of California Irvine, 8788, Urology, 333 City Blvd West, Orange, California, United States, 92868.,Kansas City University of Medicine and Biosciences, 32959, Kansas City, Missouri, United States, 64106-1453;
| | - Akhil Peta
- University of California Irvine, 8788, Urology, 333 City Blvd, Suite 2170, Orange, California, United States, 92868;
| | - Roshan M Patel
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Benjamin Dolan
- University of California, Irvine, Engineering, Irvine, California, United States;
| | - Jaime Landman
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Ralph Clayman
- University of California Irvine, 8788, Urology, Orange, California, United States;
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Bozzini G, Filippi B, Alriyalat S, Calori A, Besana U, Mueller A, Pushkar D, Romero-Otero J, Pastore A, Sighinolfi MC, Micali S, Buizza C, Rocco B. Disposable versus Reusable Ureteroscopes: A Prospective Multicenter Randomized Comparison. Res Rep Urol 2021; 13:63-71. [PMID: 33604311 PMCID: PMC7882796 DOI: 10.2147/rru.s277049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose To compare reusable and disposable flexible ureteroscopes in terms of efficacy and safety for patients undergoing Retrograde Intrarenal Surgery (RIRS). Patients and Methods Patients with a renal stone eligible for RIRS were enrolled in this multicenter, randomized, clinical trial study. Patients were randomized into two groups: group A (90 patients) underwent RIRS with a reusable flexible ureteroscope and group B (90 patients) were treated with a disposable one. Results The patients’ demographics, stone features and pre-operative urine cultures were comparable between the groups. The Stone Free Rates (SFRs) were not significantly different (86.6% and 90.0% for group A and group B, respectively, p=0.11) and the mean cost for each procedure was comparable (2321 € in group A vs 2543 € in group B, p=0.09). However, the days of hospitalization and of antibiotic therapy were higher in group A (p ≤ 0.05). The overall complication rate in group A was 8.8% whilst in group B it was 3.3% (p ≤ 0.05); in particular, group A exhibited a greater number of major complications (Clavien score IIIa-V). The overall postoperative infection rate was 16.6% in group A and 3.3% in group B (p ≤ 0.05). Furthermore, none of the patients in group B developed urosepsis or had a positive blood culture, while 3 patients in group A did (p<0.05). Conclusion The use of disposable ureteroscopes is characterized by significantly lower post-operative complications and infection rates, while having comparable costs and SFRs vis à vis reusable ureteroscopes. Clinical Trial Registration Number: ISRCTN92289221.
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Affiliation(s)
- Giorgio Bozzini
- Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | | | | | - Alberto Calori
- Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Umberto Besana
- Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Alexander Mueller
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Dmitri Pushkar
- Urology Department First Moscow State Medical University, Moscow, Russia
| | | | | | | | | | - Carlo Buizza
- Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Bernardo Rocco
- Urology Department, Policlinico of Modena, Modena, Italy
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20
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Banerjee I, Katz JE, Bhattu AS, Soodana NP, Deane LA, Marcovich R, Shah HN. Durability of Digital Flexible Ureteroscope in University Hospital and Ambulatory Surgical Center: Is It Time to Rethink? J Endourol 2021; 35:289-295. [PMID: 32998577 DOI: 10.1089/end.2020.0709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction and Objectives: Published literature on damages to a digital flexible ureteroscope (DFU) examines a limited number of ureteroscopes and shows wide variation in its durability. The aim of this study was to compare the primary damage location, causes of DFU damages, and the durability of Karl Storz Flex-Xc digital ureteroscope between University Hospital (UH) and Ambulatory Care Surgery Center (ASC). We also evaluated the available literature on the durability of DFU. Methods: Each damaged DFU prospectively underwent a manufacturer's evaluation to determine the reason for return and primary site of damage. Hospital data on the number of ureteroscopic procedures and damaged DFUs over 3 years were retrospectively reviewed. The possible reason for the damage was classified as either intraoperative or between the procedures. The durability of DFUs, type, and cause of damage were compared between the UH and nonteaching ASC. A chi-square test was utilized for categorical variables. When cell frequencies were <5, Fisher's exact test was used. Results: During the study period, 1211 ureteroscopies were performed and 143 ureteroscopes were returned to the manufacturer. The mean number of uses was 7.45 at the UH and 16.5 at the ASC. The location and cause of damage were similar at both locations. The most common locations of primary damage were at the angle cover (70.6%) and instrument channel (19.2%). Most damage occurred during the handling of the ureteroscopes between surgical procedures (78%). On review of the literature, we found that DFUs were 6 times more durable in a nonteaching hospital. Conclusions: The DFU was more than two times as durable in the ASC as in the UH. Most incidents occurred during handling between surgical procedures. Future research is needed to examine the impact of training and certification of support staff on durability of DFUs.
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Affiliation(s)
- Indraneel Banerjee
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jonathan E Katz
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Amit S Bhattu
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Nachiketh P Soodana
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Leslie A Deane
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Robert Marcovich
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
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21
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Gan S, Guo Z, Zou Q, Gu C, Xiang S, Li S, Ye Z, Wang S. Diagnosis accuracy of PCA3 level in patients with prostate cancer: a systematic review with meta-analysis. Int Braz J Urol 2020; 46:786-793. [PMID: 32539255 PMCID: PMC7822363 DOI: 10.1590/s1677-5538.ibju.2019.0521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/01/2019] [Indexed: 12/16/2022] Open
Abstract
Objective: This study aims to design a novel semirigid ureterorenoscope with irrigation and vacuum suction system and a modified ureteral access sheath (UAS) named Sotn ureterorenoscope® (Sotn=ShuoTong Medical Company) to overcome the deficiencies of the current procedure and to improve the efficiency and safety of using Sotn ureterorenoscope® for treatment of upper urinary calculi. Materials and Methods: Fifty-eight patients, comprising 31 males and 27 females, were evaluated. The medical records of 58 patients with upper urinary calculi treated with Sotn ureterorenoscope® from March 2015 to June 2017 were retrospectively reviewed at the Second Affiliate Hospital of Guangzhou University of Chinese Medicine in China. The primary outcome was stone-free rate (SFR) assessed by computed tomography on the 1st day and one month after treatment. The secondary outcome was postoperative complication rate. Results: The mean and SD of operative duration was 48.5 (10.4) min, and the mean and SD of stone size was 15.6 (5.6) mm. The primary overall SFR was 89.7% (52/58) and 100% at 1 month follow-up. Complication, which was Clavien I (minor fever managed by antipyretic therapy), was detected in 1.7% (1/58) of the patients. Conclusions: Sotn ureterorenoscope® is technically feasible, efficacious and safe for treatment of upper urinary calculi because of its advantages of high SFR and low complication rates.
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Affiliation(s)
- Shu Gan
- Department of Urology, The Second Affiliate Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhenlang Guo
- Department of Urology, The Second Affiliate Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qianming Zou
- Department of Urology, The Second Affiliate Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chiming Gu
- Department of Urology, The Second Affiliate Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Songtao Xiang
- Department of Urology, The Second Affiliate Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Siyi Li
- Department of Urology, The Second Affiliate Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shusheng Wang
- Department of Urology, The Second Affiliate Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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22
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Abstract
PURPOSE OF REVIEW Single-use flexible ureteroscopes (su-fURS) aim at overcoming the main limitations of conventional reusable ureteroscopes in terms of acquisition and maintenance costs, breakages, and reprocessing. However, little data exist to date regarding the superiority of su-fURS at this regard. We aimed to perform a systematic literature review on available su-fURS performance with a focus on clinical data for all articles in the last 10 years. RECENT FINDINGS To date, more than 10 different su-fURS are available on the market, with different characteristics and performance. Some of these devices have top-level features, almost catching up with those observed in reusable flexible ureteroscopes. Clinical evidence is mainly available only for two models, LithoVue and Uscope PU3022, and to date it is not strong enough to support routine adoption and use of su-fURS, with a consequent lack of consensus of specific clinical indications. Cost-effectiveness analyses seem to indicate an economic disadvantage in the routine adoption of su-fURS. Environmental issues related to the use of su-fURS also remain to be inquired and addressed. SUMMARY Since their introduction, su-fURS have gained widespread popularity. Despite their ability at addressing reusable ureteroscope limitations, high-cost and a substantial lack of evidence are still limiting their routine adoption.
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Ventimiglia E, Godínez AJ, Traxer O, Somani BK. Cost comparison of single-use versus reusable flexible ureteroscope: A systematic review. Turk J Urol 2020; 46:S40-S45. [PMID: 32877637 DOI: 10.5152/tud.2020.20223] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/21/2020] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Eugenio Ventimiglia
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France.,Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Olivier Traxer
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
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24
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Barone B, Crocetto F, Vitale R, Di Domenico D, Caputo V, Romano F, De Luca L, Bada M, Imbimbo C, Prezioso D. Retrograde intra renal surgery versus percutaneous nephrolithotomy for renal stones >2 cm. A systematic review and meta-analysis. MINERVA UROL NEFROL 2020; 72:441-450. [DOI: 10.23736/s0393-2249.20.03721-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Eisel M, Strittmatter F, Ströbl S, Freymüller C, Pongratz T, Sroka R. Comparative investigation of reusable and single-use flexible endoscopes for urological interventions. Sci Rep 2020; 10:5701. [PMID: 32231344 PMCID: PMC7105476 DOI: 10.1038/s41598-020-62657-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 03/17/2020] [Indexed: 11/18/2022] Open
Abstract
In order to evaluate the technical adaptability of a type of disposable endoscope compared to reusable flexible endoscopes, in vitro and in vivo studies were conducted. A disposable digital ureteroscope ("chip on tip") and two reusable endoscopes were investigated with respect to spatial resolution, geometric distortion in air and water the maximum. Additionally, the clinical performance of the disposable device was tested during clinical procedures (n = 20). The disposable endoscope showed an optical resolution of 6.72 lines/mm at 10 mm distance, similar to the other devices. In comparison, the disposable endoscope showed a barrel-shaped image distortion in air of -24.2%, which is in the middle range, but was best under water (-8.6%). The bendability of 297° (275 µm fiber) and 316° (empty channel, 1.5 F basket) and the maximum irrigation (1 m: 58.1 ml/min, 2 m: 91.9 ml/min) were convincing. Clinically the maneuverability was very good in (13/20), good or satisfactory in (7/20). Visibility was evaluated as very good in (11/20), just in (1/20) either satisfactory or sufficient. The consistency of visibility was not affected in (19/20). In all cases there were no adverse events. The technical examination and clinical application of the disposable endoscope are of equal quality compared to reusable devices. Disposable endoscopes can be an alternative to reusable devices, but economic aspects such as reduction of repair costs, sterilization effort and additional waste must be taken into account.
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Affiliation(s)
- Maximilian Eisel
- Laser-Forschungslabor, LIFE-Zentrum, University Hospital of Munich, Munich, Germany.
- Department of Urology, University Hospital of Munich, Munich, Germany.
| | | | - Stephan Ströbl
- Laser-Forschungslabor, LIFE-Zentrum, University Hospital of Munich, Munich, Germany
- Department of Urology, University Hospital of Munich, Munich, Germany
| | - Christian Freymüller
- Laser-Forschungslabor, LIFE-Zentrum, University Hospital of Munich, Munich, Germany
- Department of Urology, University Hospital of Munich, Munich, Germany
| | - Thomas Pongratz
- Laser-Forschungslabor, LIFE-Zentrum, University Hospital of Munich, Munich, Germany
- Department of Urology, University Hospital of Munich, Munich, Germany
| | - Ronald Sroka
- Laser-Forschungslabor, LIFE-Zentrum, University Hospital of Munich, Munich, Germany
- Department of Urology, University Hospital of Munich, Munich, Germany
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26
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Salvadó JA, Cabello JM, Moreno S, Cabello R, Olivares R, Velasco A. Endoscopic treatment of lower pole stones: is a disposable ureteroscope preferable? Results of a prospective case-control study. Cent European J Urol 2019; 72:280-284. [PMID: 31720031 PMCID: PMC6830478 DOI: 10.5173/ceju.2019.1962] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/29/2019] [Accepted: 08/19/2019] [Indexed: 01/06/2023] Open
Abstract
Introduction The best option for lower pole stone management is still under debate. With the recent incorporation of disposable ureteroscopes, discussion on this topic has been renewed. The aim of the present study was to compare the results obtained with flexible disposable ureteroscopes with those obtained using reusable ureteroscopes in the treatment of inferior calyx stones. Material and methods A case-control study was carried out using data registered prospectively in a database at our center. The clinical results obtained in two groups of patients were analyzed. In the first group of patients, a reusable flexible fiber-optic ureteroscope (Cobra®, Richard Wolf) was used, and in the second group, a disposable flexible ureteroscope was used (Uscope 3022®, Pusen Medical). The variables analyzed included: operative time, fluoroscopy time, need for postprocedure ureteral catheter, stone-free rate (fragments <1 millimeter) and complications. The results were evaluated using a Student's t test, a Mann-Whitney test and a Fisher's test. Results There were 31 cases with disposable ureteroscopes and 30 cases with a reusable ureteroscope. Both groups were comparable in their demographic and clinical variables. The characteristics regarding length, width and angle of the infundibulum (measured by retrograde ureteropyelography) were also comparable. There were no differences in the clinical findings with respect to the stone-free rate, need for a ureteral catheter, complications or hospital stay. Significant differences were found in the average surgery time (56.1 vs. 77 minutes; P = 0.01) and in the fluoroscopy time (66.1 vs. 83.4 seconds; P = 0.02), both favoring the use of single use ureteroscopes. Conclusions In this study, disposable flexible ureteroscopes have been validated as an option that is in the least equivalent to reusable ureteroscopes based on clinical results. The shorter surgical and fluoroscopy durations are possible advantages considering the high costs associated with time spent in the operating room and the need to reduce ionizing radiation.
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Affiliation(s)
- José A Salvadó
- Department of Urology, Clínica Santa María, Santiago, Chile.,Universidad Finis Terrae, Santiago, Chile
| | - José M Cabello
- Department of Urology, Clínica Santa María, Santiago, Chile.,Universidad Finis Terrae, Santiago, Chile
| | - Sergio Moreno
- Department of Urology, Clínica Santa María, Santiago, Chile
| | - Renato Cabello
- Department of Urology, Clínica Santa María, Santiago, Chile
| | - Ruben Olivares
- Department of Urology, Clínica Santa María, Santiago, Chile.,Universidad Finis Terrae, Santiago, Chile
| | - Alfredo Velasco
- Department of Urology, Clínica Santa María, Santiago, Chile.,Universidad Finis Terrae, Santiago, Chile
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27
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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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28
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Hosny K, Clark J, Srirangam SJ. Handling and protecting your flexible ureteroscope: how to maximise scope usage. Transl Androl Urol 2019; 8:S426-S435. [PMID: 31656748 DOI: 10.21037/tau.2019.07.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Flexible ureteroscopy is an important therapeutic and diagnostic procedure and has seen rapid rise in its utilisation in recent years. There have been numerous developments in flexible ureteroscope (fURS) technology but scope fragility, and the associated high maintenance costs, remains a concern. A comprehensive Medline search for related publications from the last 20 years was undertaken to identify common causes of fURS damage and ascertain practices to minimise this. Flexible ureteroscopy can be due to intraoperative causes (loss of the deflection mechanism, damage to the working channel due and fibreoptic bundle injury) and non-operative damage which occur during cleaning, sterilisation and handling of the fURS. The review summarises the available literature to help highlight common mechanisms of scope damage, and outlines evidence-based measures to reduce the risk of damage and maximise durability. Scope fragility remains a problem with significant associated cost implications. In a culture of rising fURS use and reducing re-imbursement for endourologists, prolonging the longevity of the fURS is imperative for maintaining profitability. There are simple and inexpensive practices which can be immediately adopted to maximise fURS use and reduce the need for repairs.
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Affiliation(s)
- Khaled Hosny
- Department of Urology, Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn BB2 3HH, UK
| | - Jennifer Clark
- Department of Urology, Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn BB2 3HH, UK
| | - Shalom J Srirangam
- Department of Urology, Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn BB2 3HH, UK
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29
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Lu S, Cottone CM, Yoon R, Jefferson FA, Sung JM, Okhunov Z, Tapiero S, Patel RM, Landman J, Clayman RV. Endockscope: A Disruptive Endoscopic Technology. J Endourol 2019; 33:960-965. [PMID: 31195831 DOI: 10.1089/end.2019.0252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective: To assess optical performance and diagnostic capability of the Endockscope system (ES) vs the standard endoscopic system (SES) using four rigid/semi-rigid endoscopes. The ES combines a smartphone, lens system, and a rechargeable light-emitting diode (LED) light source to provide a low-cost alternative ($45) to the standard camera and high-powered light source ($45,000) used in endoscopic procedures. Materials and Methods: Video clips (<20 seconds) of standard rigid nephroscopy, semi-rigid ureteroscopy, rigid cystoscopy, and laparoscopy in two adult male cadavers were recorded using the ES combined with either the Apple iPhone X or Samsung Galaxy S9+ and also with the high-definition SES (Karl Storz). Sixteen urologists blinded to the camera modality assessed the image resolution, brightness, color, sharpness, and overall quality using a Likert-type scale; acceptability for diagnostic purposes was judged on a binary scale (yes/no). Results: For rigid cystoscopy, there was no statistical difference between both ES systems and the SES. For semi-rigid ureteroscopy the two ES systems performed equal to or better than the SES. For rigid nephroscopy, the ES plus Galaxy was comparable to the SES, except in brightness (p < 0.05), whereas the ES plus iPhone was inferior in various parameters. For laparoscopy, the ES plus Galaxy was inferior to the SES in brightness and overall quality (p < 0.05); the ES plus iPhone was inferior for all laparoscopic image parameters compared with the SES. For diagnostic purposes, the ES plus Galaxy was equivalent to the SES for all endoscopes; the ES plus iPhone was equivalent to the SES for cystoscopy, ureteroscopy, and nephroscopy. Conclusion: The ES plus the Apple iPhone X or Samsung Galaxy S9+ offers comparable imaging and provides diagnostic information equivalent to the standard system for rigid endoscopy of the kidney, ureter, and bladder; the Galaxy S9+ provides comparable imaging and diagnostic capabilities for evaluation of the abdomen.
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Affiliation(s)
- Sherry Lu
- Department of Urology, University of California, Irvine, Orange, California
| | - Courtney M Cottone
- Department of Urology, University of California, Irvine, Orange, California
| | - Renai Yoon
- Department of Urology, University of California, Irvine, Orange, California
| | | | - John M Sung
- Department of Urology, University of California, Irvine, Orange, California
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, Orange, California
| | - Shlomi Tapiero
- Department of Urology, University of California, Irvine, Orange, California
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, Orange, California
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California
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30
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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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31
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Sultan S, Aba Umer S, Ahmed B, Naqvi SAA, Rizvi SAH. Update on Surgical Management of Pediatric Urolithiasis. Front Pediatr 2019; 7:252. [PMID: 31334207 PMCID: PMC6616131 DOI: 10.3389/fped.2019.00252] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/03/2019] [Indexed: 12/15/2022] Open
Abstract
Urolithiasis has always been a fascinating disease, even more so in children. There are many intriguing facets to this pathology. This article is a nonsystematic review to provide an update on the surgical management of pediatric urolithiasis. It highlights the pros and cons of various minimally invasive surgical options such as extracorporeal shockwave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), laparoscopy, and robotics. This article also describes the various intracorporeal disintegration technologies available to fragment the stone, including the newer advancements in laser technology. It also emphasizes the cost considerations especially with reference to the emerging economies. Thus, this manuscript guides how to select the least-invasive option for an individual patient, considering age and gender; stone size, location, and composition; and facilities and expertise available.
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Affiliation(s)
- Sajid Sultan
- Philip G. Ransley Department of Paediatric Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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32
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Meria P. Re: Single-use Versus Reusable Ureterorenoscopes for Retrograde Intrarenal Surgery (RIRS): Systematic Comparative Analysis of Physical and Optical Properties in Three Different Devices. Eur Urol 2019; 76:125. [PMID: 30879793 DOI: 10.1016/j.eururo.2019.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/27/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Paul Meria
- St-Louis hospital, department of urology, 1 avenue Claude Vellefaux, Paris, France.
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33
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Which flexible ureteroscope is the best for upper tract urothelial carcinoma treatment? World J Urol 2019; 37:2325-2333. [PMID: 30770944 DOI: 10.1007/s00345-019-02675-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/05/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To present attributes of currently available flexible ureteroscopes to define the best flexible ureteroscope for upper tract urothelial carcinoma (UTUC) treatment. MATERIALS AND METHODS Scopus and Medline databases were searched for articles relating to performance of flexible ureteroscopes. A consensus for final inclusion of articles judged to be relevant for UTUC treatment was reached between the authors. Instrument characteristics were extracted from manufacturers' product brochures. RESULTS Smaller cross-sectional size of instruments is associated with increased probability for successful primary access to the upper urinary tract. The smallest flexible ureteroscopes are fiberoptic scopes. Smaller ureteroscopes also allow comparatively increased irrigation flow at constant intrarenal pressure. Digital flexible ureteroscopes achieve superior image quality compared to their fiberoptic counterparts, at the price of lower end-deflection ability. Image enhancement technologies such as narrow-band imaging (NBI), photodynamic diagnosis (PDD) and Image 1-S (formerly SPIES) are based on subjective image interpretation by the operator. NBI and PDD significantly increase tumor detection rate. The highest subjective image quality score of the Image 1-S technology is reached by the "Clara + Chroma" mode. Single-use ureteroscopes offer potential advantages over reusable scopes, including sterility, absence of contamination, immediate availability and exemption of previous instrument wear. CONCLUSIONS Miniaturization, digital image caption and image enhancement technologies seem to be the major determinants defining the best flexible ureteroscope for UTUC treatment. The impact of further factors, such as distal tip design, torque, working channel position, risk of contamination, as well as upcoming technological innovations should be evaluated in randomized controlled trials.
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