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Talyshinskii A, Hameed BMZ, Naik N, Adhikari K, Zhanbyrbekuly U, Juliebø-Jones P, Somani BK. Being all-seeing gymnast within kidney cavity: analysis of the optical and flexibility characteristics trends of 61 flexible ureteroscopes over four decades. Urolithiasis 2024; 52:92. [PMID: 38884642 DOI: 10.1007/s00240-024-01591-2] [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: 05/12/2024] [Accepted: 06/06/2024] [Indexed: 06/18/2024]
Abstract
The purpose of this review is to analyze the trend in optical features and flexibility changes of flexible ureteroscopes over the past decades, and determine the correlation of individual parameters with release period as well as with dimensional parameters. Flexible ureteroscopes mentioned in the literature or those commercially available were searched. To minimize the search bias, the instruments were grouped by release date time-periods of < 2000 year, 2000-2009, 2010-2019, and 2020 onwards. The final review included only those instrument models for which data on minimum and maximum depth of field, field of view, direction of view, and deflection degree had been determined. The correlation among features investigated as well as with release period was also determined. 61 models of flexible ureteroscopes (27 fibreoptic and 34 digital scopes) were included. Among the different features investigated among fiberoptic endoscopes, minimum depth of field positively and negatively correlated with channel size and field of view, respectively, whereas maximum depth of view and field of view positively correlated with overall shaft and deflection degree, respectively. Up and down deflection strongly correlated with each other and both were negatively proportional to the distal tip size. For the digital endoscopes, minimum depth of field negatively and positively correlated with distal tip size and working length, respectively. Maximum depth of field positively correlated with field of view, whereas the latter was negatively proportional to the overall shaft. As for the fiberoptic counterparts, up and down deflection strongly correlated with each other. Field of view, up and down deflection of fiberoptic flexible ureteroscopes, were significantly increased among fiberoptic and digital endoscopes over decades. As flexible ureteroscopy technology has evolved, there has been a trend towards increasing field of view with up and down deflection. Given the importance of scope ergonomics, one aspect of this popularity is the improvement of optical characteristics and deflection degree, which significantly correlates with the release period.
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Affiliation(s)
- Ali Talyshinskii
- Department of Urology, Astana Medical University, Astana, Kazakhstan
- Department of Urology and Andrology, Astana Medical University, Astana, Kazakhstan
| | - B M Zeeshan Hameed
- Department of Urology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Nithesh Naik
- Department of Mechanical and Industrial Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Kinju Adhikari
- Department of Urology, HCG Cancer Centre of Bangalore, Bangalore, Karnataka, India
| | | | | | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
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Talyshinskii A, Hameed BMZ, Naik N, Guliev B, Zhanbyrbekuly U, Khairley G, Juliebø-Jones P, Somani BK. Miniaturization of flexible ureteroscopes: a comparative trend analysis of 59 flexible ureteroscopes. Urolithiasis 2023; 52:16. [PMID: 38117336 DOI: 10.1007/s00240-023-01511-w] [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: 10/07/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023]
Abstract
The purpose of this review is to analyze the trend in miniaturization of flexible ureteroscopes over the past decades, identify the advantages and disadvantages, and determine the correlation of individual parameters with release period. Flexible ureteroscopes mentioned in the literature or those commercially available were searched. To minimize the search bias, the instruments were grouped by release date time periods of < 2000 year, 2000-2009, 2010-2019, and 2020 onwards. The final review included only those instrument models for which data on tip size, overall shaft, working length and channel size had been determined. The correlation among features investigated as well as with release period was also determined. 59 models of flexible ureteroscopes (26 fiber optic and 33 digital scopes) were included. Among the different features investigated among fiber optic endoscopes, only the sizes of the distal tip and overall shaft positively correlated with each other. In contrast to their fiber optic counterparts, a strong positive correlation was observed between tip and channel sizes, whereas negative correlation was found between channel size and overall shaft size and working length of digital scopes. Only distal tip of fiber optic flexible ureteroscopes and overall shaft of digital endoscopes were significantly reduced over their evolution. With the development of technology, there has been an improvement of flexible ureteroscopes and one of the indicators of this trend is a decrease in their size. With a definite trend towards miniaturization over the past decades, a significant correlation was observed in tip size and overall shaft for fiber optic and digital endoscopes, respectively.
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Affiliation(s)
- Ali Talyshinskii
- Department of Urology and Andrology, Astana Medical University, Astana, Kazakhstan
| | - B M Zeeshan Hameed
- Department of Urology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Nithesh Naik
- Department of Mechanical and Industrial Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Bakhman Guliev
- Department of Urology, Mariinsky Hospital, Saint Petersburg, Russia
| | | | - Gafour Khairley
- Department of Urology and Andrology, Astana Medical University, Astana, Kazakhstan
| | | | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
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Geavlete B, Mareș C, Mulțescu R, Georgescu D, Geavlete P. Hybrid flexible ureteroscopy strategy in the management of renal stones - a narrative review. J Med Life 2022; 15:919-926. [PMID: 36188640 PMCID: PMC9514813 DOI: 10.25122/jml-2022-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022] Open
Abstract
The introduction of single-use flexible ureteroscopes (suFURSs) in daily practice tends to overcome the main limitations of reusable ureteroscopes (reFURSs), in terms of high acquisition costs, maintenance, breakages and repairing costs, reprocessing and sterilization, as retrograde intrarenal surgery (RIRS) is promoted as first-line treatment of renal stones in most cases. A hybrid strategy implies having both instruments in the armamentarium of endourology and choosing the best strategy for cost-efficiency and protecting expensive reusable instruments in selected high-risk for breakage cases such as large stones of the inferior calyx, a steep infundibulopelvic angle or narrow infundibulum, or abnormal anatomy as in horseshoe and ectopic kidney. In terms of safety and efficiency, data present suFURSs as a safe alternative considering operating time, stone-free, and complication rates. An important aspect is highlighted by several authors about reusable instrument disinfection as various pathogens are still detected after proper sterilization. This comprehensive narrative review aims to analyze available data comparing suFURSs and reFURSs, considering economic, technical, and operative aspects of the two types of instruments, as well as the strategy of adopting a hybrid approach to selecting the most appropriate flexible ureteroscope in each case.
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Affiliation(s)
- Bogdan Geavlete
- Department of Urology, Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
| | - Cristian Mareș
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
| | - Răzvan Mulțescu
- Department of Urology, Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
| | - Dragoș Georgescu
- Department of Urology, Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
| | - Petrișor Geavlete
- Department of Urology, Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
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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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Bahaee J, Plott J, Ghani KR. Single-use flexible ureteroscopes: how to choose and what is around the corner? Curr Opin Urol 2021; 31:87-94. [PMID: 33399370 DOI: 10.1097/mou.0000000000000852] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The pace of technology development with single-use endoscopy has led to a range of disposable ureteroscopes. We review the development of single-use scopes, deconstruct the basic design and functional characteristics of available devices, and discuss future directions for next-generation platforms. RECENT FINDINGS Currently available devices are differentiated on the basis of several core features. The optical, deflection and irrigation characteristics are marginally different with no device clearly superior in every category. Studies comparing single-use ureteroscopes in patients linked to outcomes are limited. The incorporation of next-generation technologies into these platforms include sensors to monitor intrarenal pressure and temperature, suction of fluid and fragments, and computer vision for artificial intelligence. SUMMARY Each ureteroscope has specific features that may be advantageous in different circumstances. Single-use devices could transform the ureteroscope from a visual conduit to a transformative surgical instrument that improves outcomes and reduces complications.
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Affiliation(s)
| | - Jeffrey Plott
- Coulter Program, Department of Biomedical Engineering, University of Michigan
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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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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Pallauf M, Sevcenco S, Steiner C, Drerup M, Mitterberger M, Colleselli D, Lusuardi L, Kunit T. LithoVue™ for renal stone therapy - a perfect fit for high volume academic centers; a retrospective evaluation of 108 cases. BMC Urol 2020; 20:56. [PMID: 32423440 PMCID: PMC7236187 DOI: 10.1186/s12894-020-00624-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/29/2020] [Indexed: 11/29/2022] Open
Abstract
Background Over the last few years the number of flexible ureterorenoscopies, used for renal stone treatment, has risen steadily. This was associated with an increase in costs for maintenance and repair of the fragile ureterorenoscopes used. To overcome this problem single-use devices have been introduced to the market. The aim of this study was to assess surgical outcome and workability for LithoVue™, a single-use flexible ureterorenoscope. Methods We retrospectively analyzed all flexible ureterorenoscopies performed at our department between January and October 2017. We included a total of 108 interventions for renal stone therapy, all performed using the single-use device LithoVue™. We assessed patients’ characteristics including stone size, count and location. We evaluated the surgical outcome, analyzing stone-free rates, reintervention rates, complication rates, as well as surgery time. Learning curve for single-use ureterorenoscopes was evaluated by comparing the surgical outcome between residents and consultants. Results The average time needed per intervention was 52,31 min ± 28,11. In 77 out of 108 (71,30%) patients we were able to remove all stones by a single intervention. In 8 patients (7,41%) intra- or postoperative complications occurred, none of which was graded higher than Clavien-Dindo III B. We did not find any statistical differences comparing the surgical outcome between residents and consultants. No technical difficulties occurred during surgery. Conclusion Single-use flexible ureterorenoscopes provide decent working properties resulting in good surgical outcome. Furthermore, they are proven to be easy to handle even for unexperienced surgeons, making them a feasible choice for high volume academic centers.
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Affiliation(s)
- Maximilian Pallauf
- Landeskrankenhaus Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Universitätsklinik für Urologie und Andrologie, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Sabina Sevcenco
- Abteilung für Urologie und Andrologie, Sozialmedizinisches Zentrum Ost - Donauspital, Langobardenstraße 122, 1220, Wien, Austria
| | - Christopher Steiner
- Landeskrankenhaus Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Universitätsklinik für Urologie und Andrologie, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Martin Drerup
- Landeskrankenhaus Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Universitätsklinik für Urologie und Andrologie, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Michael Mitterberger
- Landeskrankenhaus Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Universitätsklinik für Urologie und Andrologie, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Daniela Colleselli
- Landeskrankenhaus Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Universitätsklinik für Urologie und Andrologie, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Lukas Lusuardi
- Landeskrankenhaus Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Universitätsklinik für Urologie und Andrologie, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Thomas Kunit
- Landeskrankenhaus Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Universitätsklinik für Urologie und Andrologie, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
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Critical Assessment of Single-Use Ureteroscopes in an In Vivo Porcine Model. Adv Urol 2020; 2020:3842680. [PMID: 32395126 PMCID: PMC7201811 DOI: 10.1155/2020/3842680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/09/2020] [Indexed: 11/18/2022] Open
Abstract
Methods A female pig was placed under general anesthesia and positioned supine, and retrograde access to the renal collecting system was obtained. The LithoVue (Boston Scientific) and Uscope (Pusen Medical) were evaluated by three experienced surgeons, and each surgeon started with a new scope. The following parameters were compared between each ureteroscope: time for navigation to upper and lower pole calyces with and without implements (1.9 F basket, 200 μm laser fiber, and 365 μm laser fiber for upper only) in the working channel and subjective evaluations of maneuverability, irrigant flow through the scope, lever force, ergonomics, and scope optics. Results Navigation to the lower pole calyx was significantly faster with LithoVue compared to Uscope when the working channel was empty (24.3 vs. 49.4 seconds, p < 0.01) and with a 200 μm fiber (63.6 vs. 94.4 seconds, p=0.04), but not with the 1.9 F basket. Navigation to the upper pole calyx was similar for all categories except faster with LithoVue containing the 365 μm fiber (67.1 vs. 99.7 seconds, p=0.02). Subjective assessments of scope maneuverability to upper and lower pole calyces when the scope was empty and with implements favored LithoVue in all categories, as did assessments of irrigant flow, illumination, image quality, and field of view. Both scopes had similar scores of lever force and ergonomics. Conclusions In an in vivo porcine model, the type of single-use ureteroscope employed affected the navigation times and subjective assessments of maneuverability and visualization. In all cases, LithoVue provided either equivalent or superior metrics than Uscope. Further clinical studies are necessary to determine the implications of these findings.
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Qi S, Yang E, Bao J, Yang N, Guo H, Wang G, Li N, Cui X, Gao W, Ou T, Wang J, Wang Z, Niu Y. Single-Use Versus Reusable Digital Flexible Ureteroscopes for the Treatment of Renal Calculi: A Prospective Multicenter Randomized Controlled Trial. J Endourol 2019; 34:18-24. [PMID: 31432716 DOI: 10.1089/end.2019.0473] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: To compare the efficacy and safety of a single-use digital flexible ureteroscope (f-URS) and a reusable digital f-URS (URF-V) for the treatment of renal stones in adults. Patients and Methods: In this randomized open-label noninferiority trial, we randomly selected patients with renal stones to receive ureteroscopy through a single-use digital f-URS (ZebraScope™; Happiness Workshop, Beijing, China) or a URF-V (Olympus, Tokyo, Japan). The primary endpoint was the 1-month postsurgical stone-free rate (SFR). The secondary efficacy endpoints assessed were the high-quality rate of images, the eligible rate of operability, the operative time, and the length of hospital stay. The safety outcomes assessed were the presence of postoperative complications, adverse events (AEs), and serious AEs (SAEs). The noninferiority margin was set at -10%. Results: In total, 126 patients completed the study (i.e., 63 patients in each group). The demographic and preoperative parameters were comparable between the two groups. The 1-month SFR was 77.78% for the ZebraScope group and 68.25% for the URF-V group (two-sided 95% confidence interval [CI]: -5.95 to 25.01). The high-quality rate of images and the eligible rate of operability were 100% in both groups (two-sided 95% CI: -5.27 to 5.35). There was no difference between the two groups in the operative time (p = 0.687), the length of hospital stay (p = 0.430), the presence of postoperative complications (p = 0.310), the presence of AEs (p = 0.709), and the presence of SAEs (p = 0.648). The most important and fatal SAE was acute urinary tract obstruction. Conclusion: The single-use digital f-URS (ZebraScope) appears to be at least noninferior to URF-V regarding the 1-month SFR, the high-quality rate of images, and the eligible rate of operability. Single-use digital f-URSs are an effective and safe alternative to URF-V.
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Affiliation(s)
- Shiyong Qi
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Enguang Yang
- Key Laboratory of Gansu Province for Urological Diseases, Gansu Nephro-Urological Clinical Center, Institute of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Junsheng Bao
- Key Laboratory of Gansu Province for Urological Diseases, Gansu Nephro-Urological Clinical Center, Institute of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Ningqiang Yang
- Key Laboratory of Gansu Province for Urological Diseases, Gansu Nephro-Urological Clinical Center, Institute of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Hongfeng Guo
- Department of Urology, Peking University Shougang Hospital, Beijing, China
| | - Gang Wang
- Department of Urology, Peking University Shougang Hospital, Beijing, China
| | - Ningchen Li
- Department of Urology, Peking University Shougang Hospital, Beijing, China
| | - Xin Cui
- Department of Urology, Capital Medical University, Beijing Xuanwu Hospital, Beijing, China
| | - Wei Gao
- Department of Urology, Capital Medical University, Beijing Xuanwu Hospital, Beijing, China
| | - Tongwen Ou
- Department of Urology, Capital Medical University, Beijing Xuanwu Hospital, Beijing, China
| | - Jiaji Wang
- Key Laboratory of Gansu Province for Urological Diseases, Gansu Nephro-Urological Clinical Center, Institute of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhiping Wang
- Key Laboratory of Gansu Province for Urological Diseases, Gansu Nephro-Urological Clinical Center, Institute of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Yuanjie Niu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
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Marchini GS, Torricelli FC, Batagello CA, Monga M, Vicentini FC, Danilovic A, Srougi M, Nahas WC, Mazzucchi E. A comprehensive literature-based equation to compare cost-effectiveness of a flexible ureteroscopy program with single-use versus reusable devices. Int Braz J Urol 2019; 45:658-670. [PMID: 31397987 PMCID: PMC6837614 DOI: 10.1590/s1677-5538.ibju.2018.0880] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/20/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To critically review all literature concerning the cost-effectiveness of flexible ureteroscopy comparing single-use with reusable scopes. MATERIALS AND METHODS A systematic online literature review was performed in PubMed, Embase and Google Scholar databases. All factors potentially affecting surgical costs or clinical outcomes were considered. Prospective assessments, case control and case series studies were included. RESULTS 741 studies were found. Of those, 18 were duplicated and 77 were not related to urology procedures. Of the remaining 646 studies, 59 were considered of relevance and selected for further analysis. Stone free and complication rates were similar between single-use and reusable scopes. Operative time was in average 20% shorter with digital scopes, single-use or not. Reusable digital scopes seem to last longer than optic ones, though scope longevity is very variable worldwide. New scopes usually last four times more than refurbished ones and single-use ureterorenoscopes have good resilience throughout long cases. Longer scope longevity is achieved with Cidex and if a dedicated nurse takes care of the sterilization process. The main surgical factors that negatively impact device longevity are lower pole pathologies, large stone burden and non-use of a ureteral access sheath. We have built a comprehensive fi nancial costeffective decision model to fl exible ureteroscope acquisition. CONCLUSIONS The cost-effectiveness of a fl exible ureteroscopy program is dependent of several aspects. We have developed a equation to allow a literature-based and adaptable decision model to every interested stakeholder. Disposable devices are already a reality and will progressively become the standard as manufacturing price falls.
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Affiliation(s)
- Giovanni S Marchini
- Seção de Endourologia da Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Fábio C Torricelli
- Seção de Endourologia da Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Carlos A Batagello
- Seção de Endourologia da Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Manoj Monga
- Seção de Endourologia da Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Fábio C Vicentini
- Seção de Endourologia da Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Alexandre Danilovic
- Seção de Endourologia da Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Miguel Srougi
- Seção de Endourologia da Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - William C Nahas
- Seção de Endourologia da Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Seção de Endourologia da Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
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12
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Johnston TJ, Baard J, de la Rosette J, Doizi S, Giusti G, Knoll T, Proietti S, Brehmer M, Emiliani E, Pérez-Fentes D, Osther PJS, Seitz C, Neal N, Turney B, Hasan M, Traxer O, Wiseman O. A clinical evaluation of the new digital single-use flexible ureteroscope (UscopePU3022): an international prospective multicentered study. Cent European J Urol 2018; 71:453-461. [PMID: 30680241 PMCID: PMC6338818 DOI: 10.5173/ceju.2018.1787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 09/29/2018] [Accepted: 09/30/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction We assessed the clinical performance of a new digital single-use flexible ureteroscope (UscopePU3022). Material and methods A prospective cohort study was carried out across 11 centers (July-Oct. 2017). The UscopePU3022 was assessed regarding ease of insertion; deflection, image quality, maneuverability and overall performance using either a visual analog* or Likert scale. Results A total of 56 procedures were performed in 11 centers (16 surgeons) with the indication being renal stones in 83%. The median score for ease of scope insertion was 10 (3-10). Intraoperative maneuverability was rated as 'good' in 38% and 'very good' in 52%. Visual quality was rated as 'poor or bad' in 18%, 'fair' in 37% and 'good or very good' in 43%. Two scopes failed intraoperatively (4%). Preoperative and postoperative median upward and downward deflection was 270 degrees. Compared to standard flexible ureteroscopy (f-URS) maneuverability was rated as 'equivalent' in 30% and 'better' in 60%; visual quality was 'worse' in 38% and 'equivalent or better' in 62%; limb fatigue scores were 'better' in 86%; and overall performance was 'worse' in 55% and 'equivalent or better' in 45%. Conclusions UscopeTM3022 performed well with regards to maneuverability, deflection and limb fatigue and appears to be at least non-inferior to standard f-URS with regards to these parameters. Poor image quality is a concern for UscopePU3022 with it receiving a low overall performance rating when compared to standard f-URS. Despite this it scored highly when investigators were asked if they would use it in their practice if it was cost-effective to do so.
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Affiliation(s)
| | - Joyce Baard
- AMC University Hospital, Department of Urology, Amsterdam, The Netherlands
| | | | - Steeve Doizi
- Orbonne Université, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon Paris, France
| | - Guido Giusti
- San Raffaele-Turro Hospital, Department of Urology, Milan, Italy
| | - Thomas Knoll
- Sindelfingen-Boeblingen Medical Center, Department of Urology, University of Tuebingen, Germany
| | - Silvia Proietti
- San Raffaele-Turro Hospital, Department of Urology, Milan, Italy
| | - Marianne Brehmer
- Danderyd University Hospital, Department of Surgery and Urology, Stockholm, Sweden
| | - Esteban Emiliani
- Fundació Puigvert, Endourology and Urolithiasis Unit, Department of Urology, Barcelona, Spain
| | - Daniel Pérez-Fentes
- Santiago de Compostela Hospital, Department of Urology, Santiago de Compostela, Spain
| | | | - Christian Seitz
- Medical University of Vienna, Department Urology, Vienna, Austria
| | - Naomi Neal
- Oxford University Hospitals, Department of Urology, Oxford, United Kingdom
| | - Ben Turney
- Oxford University Hospitals, Department of Urology, Oxford, United Kingdom
| | - Mudhar Hasan
- Danderyd University Hospital, Department of Surgery and Urology, Stockholm, Sweden
| | - Olivier Traxer
- Orbonne Université, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon Paris, France
| | - Oliver Wiseman
- Cambridge University Hospitals, Department of Urology, Cambridge, United Kingdom
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Wang F, Yang Y, Chen H, Huang H, Huang W, Weng Z, Xie H. The application of a single-use fiberoptic flexible ureteroscope for the management of upper urinary calculi. Int Urol Nephrol 2018; 50:1235-1241. [PMID: 29797215 DOI: 10.1007/s11255-018-1895-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/11/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the clinical outcomes with a Chinese single-use fiberoptic flexible ureteroscope (YouCare Tech) from a prospective database. MATERIALS AND METHODS A prospective study was conducted in a single center in China between January 2016 and October 2017. All consecutive patients who underwent flexible ureteroscopy performed by YouCare flexible ureteroscope were analyzed. Patients' demographics, clinical characteristics, intraoperative parameters, postoperative complications, and stone-free rate were evaluated and recorded. Stone-free status was defined as no visible stones or clinically insignificant residual stones < 2 mm on a postoperative image study. RESULTS A total of 684 procedures were performed for 653 patients (31 patients had bilateral stones). A double J stent had been previously placed in 431 patients. The location of the calculi was upper calyx, middle calyx, lower calyx, and renal pelvis and proximal ureter in 74, 101, 211, 115, and 183 patients, respectively. The median operative time was 52 min. The postoperative stone-free rate for the first 2 weeks after surgery was 78.5%, which increased to 91.1% at the first month. The overall stone-free rate was 95.2%. The complication rate was minor and short-term, such as gross hematuria or flank pain. CONCLUSION YouCare flexible ureteroscope can be considered effective and safe in the treatment of both upper ureteral and renal stones in selected patients. Further evaluation of comparison with other FURS's surgical outcomes and cost-effectiveness analysis will help to present the best utility of this single-use FURS in clinical practice.
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Affiliation(s)
- Feng Wang
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yu Yang
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Honde Chen
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Hang Huang
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Weiping Huang
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Zhiliang Weng
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
| | - Hui Xie
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
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Abstract
PURPOSE OF REVIEW Flexible ureteroscopy has been widely developed in the last decade been nowadays one of the first line treatment options for urolithiasis and conservative management for upper tract urothelial tumors. Even though some unfavorable features of the reusable flexible scopes can limit the surgical procedure such as their availability, lack of sterilization or costly repairs. Disposable scopes have been developed with the intention of improving such problems. RECENT FINDINGS To our knowledge, seven devices have been developed. Of the scopes features, size, deflection, image quality and ergonomic handling have to be at least as good as reusable ones as they are expected to be noninferior. Three devices match all the features of reusable scopes, although only one has been properly studied. SUMMARY Not all the available disposable devices have been properly studied or compared with standard scopes. Although some devices are promising more studies are needed to proof their benefits.
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Davis NF, Quinlan MR, Browne C, Bhatt NR, Manecksha RP, D'Arcy FT, Lawrentschuk N, Bolton DM. Single-use flexible ureteropyeloscopy: a systematic review. World J Urol 2017; 36:529-536. [PMID: 29177820 DOI: 10.1007/s00345-017-2131-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/13/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Data assessing the effectiveness of single-use flexible ureteropyeloscopy (FURS) are limited. This study evaluates and compares single-use FURS with conventional reusable FURS. METHODS A systematic search using electronic databases (Pubmed and Embase) was performed for studies evaluating single-use FURS in the setting of urinary tract stone disease. Outcome measures included a comparative evaluation of their mechanical, optical and clinical outcomes. RESULTS Eleven studies on 466 patients met inclusion criteria. In vitro comparative data were available on three single-use flexible ureteropyeloscopes (LithoVue™, Polyscope™ and SemiFlex™) and clinical data were available on two (LithoVue™ and Polyscope™). The overall stone-free rate and complication rate associated with single-use FURS was 87 ± 15% and 9.3 ± 9%, respectively. There were no significant differences in procedure duration, stone size, stone clearance and complication rates when single-use FURS and reusable FURS were compared (duration: 73 ± 27 versus 74 ± 13 min, p = 0.99; stone size: 1.36 ± 0.2 versus 1.34 ± 0.18 cm, p = 0.93; stone-free rate: 77.8 ± 18 versus 68.5 ± 33%, p = 0.76; complication rate 15.3 ± 10.6 versus 15 ± 1.6%, p = 0.3). CONCLUSIONS Single-use FURS demonstrates comparable efficacy with reusable FURS in treating renal calculi. Further studies on clinical efficacy and cost are needed to determine whether single-use FURS will reliably replace its reusable counterpart.
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Affiliation(s)
- N F Davis
- Department of Urology, Austin Hospital, Melbourne, Australia
| | - M R Quinlan
- Department of Urology, Austin Hospital, Melbourne, Australia
| | - C Browne
- Department of Urology, Tallaght Hospital, Dublin, Ireland
| | - N R Bhatt
- Department of Urology, Tallaght Hospital, Dublin, Ireland
| | - R P Manecksha
- Department of Urology, Tallaght Hospital, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - F T D'Arcy
- Department of Urology, University Hospital Galway, Galway, Ireland
| | - N Lawrentschuk
- Department of Urology, Austin Hospital, Melbourne, Australia
| | - D M Bolton
- Department of Urology, Austin Hospital, Melbourne, Australia.
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First clinical evaluation of a new single-use flexible ureteroscope (LithoVue™): a European prospective multicentric feasibility study. World J Urol 2016; 35:809-818. [PMID: 27671898 DOI: 10.1007/s00345-016-1936-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/08/2016] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION We evaluated a new digital single-use flexible ureteroscope, LithoVue™ with respect to deflection, image quality and maneuverability. METHODS A prospective cohort study was conducted in eight tertiary reference centers in Europe in December 2015 and January 2016. All consecutive patients included underwent flexible ureteroscopy and were 18 years or older. Deflection and image quality pre- and post-use and maneuverability were rated with a Likert scale. RESULTS A total of 40 procedures were performed (five per institution). The indication for FURS was treatment of renal stones in 92.5 % of the cases. Before LithoVue™ usage, the median measured upward and downward deflections were both 270°. Image quality was rated as "very good" in 65 % of cases and "good" in 30 %. Maneuverability was "very good" in 77.5 % and "good" in 17.5 %. At the final evaluation, median upward and downward deflections were both 270°. Image quality was still "very good" in 65 % of cases and "good" in 30 % with no significant difference compared with preoperative data (p = 1). Maneuverability was "very good" in 72.5 % and "good" in 17.5 %, with no significant difference compared with preoperative data (p = 0.92). Two LithoVue™ broke during surgery (5 %): one occurring in extreme deflection with acute infundibulopelvic angle and spontaneous loss of vision for the second one. CONCLUSION The LithoVue™ displayed good image quality, active deflection and maneuverability. Further evaluation of surgical outcomes and cost analysis will help to present the best utility of this single-use FURS in current practice.
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18
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Geavlete P, Multescu R, Geavlete B. Pushing the boundaries of ureteroscopy: current status and future perspectives. Nat Rev Urol 2014; 11:373-82. [PMID: 24890883 DOI: 10.1038/nrurol.2014.118] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Substantial advances in ureteroscopy have resulted in the incorporation of this procedure into routine urological practice in many centres worldwide. Subsequently, an abundance of clinical data and technological progression have enabled the development of novel solutions that have increased the efficacy of ureteroscopy, and reduced associated morbidity and costs. In addition the indications for this retrograde approach have been expanded, and pyelocalyceal diverticulum, infundibular stenosis, urolithiasis in pregnant women or in patients with urinary diversions, as well as upper urinary tract tumours can now be managed using this methodology. New endoscopes are continuously developed, with different manufacturers choosing various technical solutions to further increase the efficacy and safety-and sometimes decrease costs-of ureteroscopy, including miniaturization, inclusion of digital optical systems and dual working channels, and the introduction of disposable apparatus. The holmium laser, currently the most-versatile energy source available, enables tissue incision, tumour ablation, and intracorporeal lithotripsy. Modern ancillary instruments are diverse, flexible, and durable, and novel devices used in daily clinical practice can minimize ascendant migration of stone fragments and, therefore, decrease the failure rate of the retrograde ureteroscopic approach. However, the peak of ureteroscopy evolution seems to remain distant, with further improvement of endoscopes and ancillary instruments, and robot-assisted ureteroscopy representing only some of the areas in which future developments are possible.
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Affiliation(s)
- Petrisor Geavlete
- Urological Department, Saint John Emergency Clinical Hospital, Vitan Barzesti 13, Bucharest 042122, Romania
| | - Razvan Multescu
- Urological Department, Saint John Emergency Clinical Hospital, Vitan Barzesti 13, Bucharest 042122, Romania
| | - Bogdan Geavlete
- Urological Department, Saint John Emergency Clinical Hospital, Vitan Barzesti 13, Bucharest 042122, Romania
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Bedke J, Leichtle U, Lorenz A, Nagele U, Stenzl A, Kruck S. 1.2 French stone retrieval baskets further enhance irrigation flow in flexible ureterorenoscopy. Urolithiasis 2013; 41:153-7. [PMID: 23503877 DOI: 10.1007/s00240-012-0540-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 12/18/2012] [Indexed: 11/25/2022]
Abstract
Ureterorenoscopy (URS) has revolutionized upper urinary tract stone therapy. However, the size of the working channel and the stone baskets limit irrigation flow as well as vision. This study determined further improvements of irrigation flow, deflection capacities and impairments of breaking resistance in a new 1.2 French (F) ultra-miniaturized basket. Irrigation measurements were performed in semirigid URS (semiURS, working channel 5F) and in flexible URS (flexURS, 3.6F) in 0°, 90° and 270° deflection with 1.2F, 1.8F, 1.9F and 2.2F baskets and compared with empty channel. Breaking strength of 1.2F, 1.8F and 1.9F baskets were evaluated using a material testing machine. Tested baskets affected irrigation in semiURS and flexURS (p < 0.05). Mean ± SEM (standard error of the mean) for semiURS flow rates counted 197.1 ± 2.0, 140.9 ± 1.6, 111.1 ± 1.5, 98.0 ± 1.3 and 77.1 ± 0.9 ml/min for empty channel, 1.2F, 1.8F, 1.9F and 2.2F baskets (p < 0.05). Using unbent flexURS flow rates of 44.2 ± 0.4, 20.4 ± 0.2, 5.9 ± 0.1, 5.4 ± 0.1 and 1.5 ± 0.1 ml/min for empty channel, 1.2F, 1.8F, 1.9F and 2.2F baskets, were observed (p < 0.05). The 1.2F versus 2.2F basket showed a 13.6-fold increase in flexURS irrigation (p < 0.05), while only the 2.2F basket reduced deflection by 20.3 %. The breaking strength decreased with a reduced basket size (1.2F: 6.4 ± 0.46 vs. 1.8F: 16.8 ± 2.79 vs. 1.9F: 32.2 ± 2.74 N, p < 0.05). Ultra-miniaturized baskets of 1.2F ensured a sufficient irrigation flow as needed for high quality vision in URS stone management. However, miniaturization of the 1.2F basket resulted in a reduced breaking strength compared with larger sized devices which in turn may hamper stone removal by an increased vulnerability.
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Affiliation(s)
- Jens Bedke
- Department of Urology, University of Tuebingen, Tuebingen, Germany.
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