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Khedekar PG, Viswaroop SB, Arul M, Gopalakrishnan G, Kandasami SV. The cost-effectiveness of reusable flexible ureteroscopes: An institutional audit. Indian J Urol 2024; 40:179-184. [PMID: 39100613 PMCID: PMC11296592 DOI: 10.4103/iju.iju_41_24] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/30/2024] [Accepted: 05/16/2024] [Indexed: 08/06/2024] Open
Abstract
Introduction A flexible ureteroscope (FU) is an important tool in the urologist's armamentarium. This study aims to check the durability and cost-effectiveness of conventional FU. Methods The institution registry of damaged FU over the last 7 years was reviewed. A total of 17 flexible scopes were used. The data of 13 scopes (11 Storz fiberoptic and 2 Seesheen digital) are included in this study. A total of 1905 cases were performed. The cost of scope, duration of use, number of cases done by each scope, and nature of damage were evaluated. We compared the cost-effectiveness of conventional scopes with published costs on disposable scopes. Results The mean number of cases done by fiberoptic scope was 159 (range 25-334). The total cases done by 2 digital scopes were 135 and 25. The mean life of fiberoptic and digital scopes was 17 (range 4-31) and 8 months, respectively. The mean cost of fiberoptic scope was Indian Rupee (INR) 338,951 ($4082.7221) and INR 525,000 ($6323.7138) for digital scope. The cost per case for reusable scope is calculated by dividing the mean cost of FU by the mean number of cases done. The reprocessing cost of INR 527 was then added. Thus, the average cost per procedure for fiberoptic and digital FU was INR 2658.76 and INR 7089.50, respectively. We compared this cost with a projected cost of disposable FUbased on today's market data, which ranged from INR 60,000 to 107,427. Conclusions The reusable scopes are durable, cost-effective, and an excellent option for high case-load institutions.
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Affiliation(s)
- Pranalee G. Khedekar
- Department of Urology, Vedanayagam Hospital and PG Institute, Coimbatore, Tamil Nadu, India
| | - S. Bobby Viswaroop
- Department of Urology, Vedanayagam Hospital and PG Institute, Coimbatore, Tamil Nadu, India
| | - M. Arul
- Department of Urology, Vedanayagam Hospital and PG Institute, Coimbatore, Tamil Nadu, India
| | - Ganesh Gopalakrishnan
- Department of Urology, Vedanayagam Hospital and PG Institute, Coimbatore, Tamil Nadu, India
| | - S. V. Kandasami
- Department of Urology, Vedanayagam Hospital and PG Institute, Coimbatore, Tamil Nadu, India
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Prata F, Cacciatore L, Salerno A, Tedesco F, Ragusa A, Basile S, Iannuzzi A, Testa A, Raso G, D’Addurno G, Fantozzi M, Ricci M, Minore A, Civitella A, Scarpa RM, Papalia R. Urinary Tract Infection Predictors in Patients Undergoing Retrograde IntraRenal Surgery for Renal Stones: Does the Instrument Make the Difference? J Clin Med 2024; 13:2758. [PMID: 38792300 PMCID: PMC11122071 DOI: 10.3390/jcm13102758] [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: 03/29/2024] [Revised: 05/03/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Retrograde intrarenal surgery (RIRS) using flexible ureterorenoscopes is a cornerstone approach for renal stone removal, yet it carries a significant risk of postoperative urinary tract infection (UTI). With the emergence of single-use ureterorenoscopes, there is growing interest in their potential to mitigate this risk. This study aimed to compare the postoperative infection rates between single-use and multi-use ureterorenoscopes in RIRS procedures and to identify predictors of postoperative UTI. Methods: Data were collected from 112 consecutive patients who underwent RIRS for renal stones between March 2022 and September 2023. Peri-operative variables including age, gender, body mass index (BMI), stone size, stone location, type of ureterorenoscope, Hounsfield Units (HU), pre-operative hydronephrosis, laboratory analysis, and operative time were evaluated. Univariate and multivariate logistic regression analyses were performed to assess the predictors of postoperative UTI. Results: Of the cohort, 77 surgeries (68.7%) utilized multi-use ureterorenoscopes, while 35 (31.3%) utilized single-use devices. Stone diameter, number of stones, type of ureterorenoscope, and operative time were significant predictors of postoperative UTI in the univariate analysis. Multivariable logistic regression showed that operative time (OR, 1.3; 95% CI, 0.55-0.99; p = 0.03) and type of ureterorenoscope (multi-use vs. single-use) (OR, 1.14; 95% CI, 1.08-1.2; p < 0.001) were independent predictors of postoperative UTI. Conclusions: In conclusion, this study highlights that multi-use ureterorenoscopes and prolonged operative time are associated with an increased risk of postoperative UTI in RIRS procedures. Careful pre-operative evaluation and meticulous patient selection are essential to minimize the occurrence of postoperative UTIs and optimize patient outcomes in RIRS for renal stones.
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Affiliation(s)
| | - Loris Cacciatore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy; (F.P.); (A.S.); (F.T.); (A.R.); (S.B.); (A.I.); (A.T.); (G.R.); (G.D.); (M.F.); (M.R.); (A.M.); (A.C.); (R.M.S.); (R.P.)
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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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Juliebø‐Jones P, Ventimiglia E, Somani BK, Æsøy MS, Gjengstø P, Beisland C, Ulvik Ø. Single use flexible ureteroscopes: Current status and future directions. BJUI COMPASS 2023; 4:613-621. [PMID: 37818020 PMCID: PMC10560621 DOI: 10.1002/bco2.265] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/18/2023] [Accepted: 06/04/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction Single use ureteroscopes are a technological innovation that have become available in the past decade and gained increased popularity. To this end, there are now an increasing number of both benchside and clinical studies reporting outcomes associated with their use. Our aim was to deliver a narrative review in order to provide an overview of this new technology. Methods A narrative review was performed to gain overview of the history of the technology's development, equipment specifications and to highlight potential advantages and disadvantages. Results Findings from preclinical studies highlight potenial advantages in terms of the design of single use ureteroscopes such as the lower weight and more recent modifications such as pressure control. However, concerns regarding plastic waste and environmental impact still remain unanswered. Clinical studies reveal them to have a non inferior status for outcomes such as stone free rate. However, the volume of evidence, especially in terms of randomised trials remains limited. From a cost perspective, study conclusions are still conflicting and centres are recommended to perform their own micro cost analyses. Conclusions Most clinical outcomes for single use ureteroscopes currently match those achieved by reusable ureteroscopes but the data pool is still limited. Areas of continued debate include their environmental impact and cost efficiency.
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Affiliation(s)
- Patrick Juliebø‐Jones
- Department of UrologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
- EAU YAU Urolithiasis groupArmhemNetherlands
| | - Eugenio Ventimiglia
- EAU YAU Urolithiasis groupArmhemNetherlands
- Department of UrologyIRCCS Ospedale San RaffaeleMilanItaly
| | | | | | - Peder Gjengstø
- Department of UrologyHaukeland University HospitalBergenNorway
| | - Christian Beisland
- Department of UrologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Øyvind Ulvik
- Department of UrologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
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Mille E, El-Khoury E, Haddad M, Pinol J, Charbonnier M, Gastaldi P, Dariel A, Merrot T, Faure A. Comparison of single-use flexible ureteroscopes with a reusable ureteroscope for the management of paediatric urolithiasis. J Pediatr Urol 2023:S1477-5131(23)00017-7. [PMID: 36746718 DOI: 10.1016/j.jpurol.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION To compare the efficacy, side effects, and cost-effectiveness between a single-use digital flexible ureteroscope and a reusable flexible ureteroscope in the treatment of paediatric renal stones. METHODS This analytic, case-control, monocentric study included all patients undergoing flexible ureterosopies for stone treatment. Between April 2016 and February 2019, a reusable (Flex-XC®, Karl Storz) flexible ureteroscope was used (control group), whereas a single-use (Uscope®, PUSEN Medical©) flexible ureteroscope was used in all procedures from March 2019 to April 2021. Clinical and procedural outcomes, operative times, complication rates, hospital stay, and costs per procedure were evaluated. RESULTS Forty-three cases using a reusable flexible ureteroscope and thirty-nine using a single-use flexible ureteroscope were included in the study. Demographic patient characteristics, stone burden, location and composition, preoperative presence of a double-J stent, procedural outcomes, mean length of postoperative hospital stay, and complications (4.6% versus 5%, p = 0.81) were comparable between the two groups. Median operative duration for stone removal was 93 min (20-170) with reusable versus 81 min (55-107) with the single-use scope (p = 0.18). Scope failure occurred four times with the reusable scope and in no case with the single-use. The total cost per procedure associated with the use of single-use scopes (798 Euros) was lower than a reusable scope (1483.23 Euros). DISCUSSION Single-use flexible ureteroscopes were created to bypass the problems incurred when reusable scopes were damaged and therefore not available for use in surgical procedures. Single-use flexible ureteroscopes are always immediately available and ready to be used, even in urgent cases, as they typically do not require maintenance or sterilization. Compared with their reusable counterparts, single-use flexible ureteroscopes have similar digital performance (270°), image quality and we found no difference in the success and complication rates. Cost analysis of a reusable flexible ureteroscope must consider the purchase price, maintenance and repair costs, and decontamination costs (including handling, detergent, bacterial culture, transportation, and storage costs). In contrast, only purchase price is included in cost analysis for single-use flexible ureteroscopes. Our study suggests that single-use flexible ureteroscopes may be associated with lower costs per procedure than their reusable counterparts. CONCLUSION Single-use flexible ureteroscopes are an interesting alternative to their reusable counterparts, particularly in terms of material resource management. Cost analyses conducted using a low volume of cases representative of a paediatric urology division favour the use of single-use ureteroscopes.
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Affiliation(s)
- Eva Mille
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Eliane El-Khoury
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Mirna Haddad
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Jessica Pinol
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Matthieu Charbonnier
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Pauline Gastaldi
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Anne Dariel
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Thierry Merrot
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Alice Faure
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France.
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Abstract
OBJECTIVE Although value-based healthcare (VBHC) views accurate cost information to be crucial in the pursuit of value, little is known about how the costs of care should be measured. The aim of this review is to identify how costs are currently measured in VBHC, and which cost measurement methods can facilitate VBHC or value-based decision making. DESIGN Two reviewers systematically search the PubMed/MEDLINE, Embase, EBSCOhost and Web of Science databases for publications up to 1 January 2022 and follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify relevant studies for further analysis. ELIGIBILITY CRITERIA Studies should measure the costs of an intervention, treatment or care path and label the study as 'value based'. An inductive qualitative approach was used to identify studies that adopted management accounting techniques to identify if or how cost information facilitated VBHC by aiding decision-making. RESULTS We identified 1930 studies, of which 215 measured costs in a VBHC setting. Half of these studies measured hospital costs (110, 51.2%) and the rest relied on reimbursement amounts. Sophisticated costing methods that allocate both direct and indirect costs to care paths were seen as able to provide valuable managerial information by facilitating care path adjustments (39), benchmarking (38), the identification of cost drivers (47) and the measurement of total costs or cost savings (26). We found three best practices that were key to success in cost measurement: process mapping (33), expert input (17) and observations (24). CONCLUSIONS Cost information can facilitate VBHC. Time-driven activity-based costing (TDABC) is viewed as the best method although its ability to inform decision-making depends on how it is implemented. While costing short, or partial, care paths and surgical episodes produces accurate cost information, it provides only limited decision-making information. Practitioners are advised to focus on costing full care cycles and to consider both direct and indirect costs through TDABC.
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Affiliation(s)
- Maura Leusder
- Erasmus School of Health Policy & Management, Department Health Services Management & Organization, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Petra Porte
- Erasmus School of Health Policy & Management, Department Health Services Management & Organization, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Department Health Services Management & Organization, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Hilco van Elten
- Erasmus School of Health Policy & Management, Department Health Services Management & Organization, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Center for Corporate Reporting, Finance & Tax, Nyenrode Business Universiteit, Breukelen, The Netherlands
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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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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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Knoedler MA, Best SL. Disposable Ureteroscopes in Urology: Current State and Future Prospects. Urol Clin North Am 2021; 49:153-159. [PMID: 34776048 DOI: 10.1016/j.ucl.2021.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Ureteroscopy is the most common surgical modality for stone treatment. Reusable flexible ureteroscopes are delicate instruments that require expensive maintenance and repairs. Multiple single use ureteroscopes have been developed recently to combat the expensive and time-intensive sterilization and repair of ureteroscopes. Although multiple studies have looked at different aspects of reusable and single use ureteroscopes, there is significant heterogeneity in performance measures and cost between the 2 categories, and neither has a clear advantage. Both can be used successfully, and individual and institution level factors should be considered when deciding which ureteroscope to use.
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Affiliation(s)
- Margaret A Knoedler
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705-2281, USA.
| | - Sara L Best
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705-2281, USA
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Mazzucchi E, Marchini GS, Berto FCG, Denstedt J, Danilovic A, Vicentini FC, Torricelli FCM, Battagello CA, Srougi M, Nahas WC. Single-use flexible ureteroscopes: update and perspective in developing countries. A narrative review. Int Braz J Urol 2021; 48:456-467. [PMID: 34786927 PMCID: PMC9060176 DOI: 10.1590/s1677-5538.ibju.2021.0475] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/31/2021] [Indexed: 11/22/2022] Open
Abstract
Flexible ureteroscopy is a well-established method for treatment of urinary stones but flexible ureteroscopes are expensive and fragile devices with a very limited lifetime. Since 2006 with the advent of digital flexible ureteroscopes a great evolution has occurred. The first single-use flexible ureteroscope was launched in 2011 and new models are coming to the market. The aim of this article is to review the characteristics of these devices, compare their results with the reusable devices and evaluate the cost-benefits of adopting single-use flexible ureteroscopes in developing countries.
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Affiliation(s)
- Eduardo Mazzucchi
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Giovanni Scala Marchini
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | | | - John Denstedt
- Division of Urology, Western University, London, Ontario, Canada
| | - Alexandre Danilovic
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Fabio Carvalho Vicentini
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Fabio Cesar Miranda Torricelli
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Carlos Alfredo Battagello
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Miguel Srougi
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - William Carlos Nahas
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
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11
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Whelan P, Kim C, Tabib C, Preminger GM, Lipkin ME. Evolution of Single-Use Urologic Endoscopy: Benchtop and Initial Clinical Assessment of a New Single-Use Flexible Cystoscope. J Endourol 2021; 36:13-21. [PMID: 34235971 DOI: 10.1089/end.2021.0219] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction Office cystoscopy is one of the most frequently performed procedures by a urologist. However, single-use cystoscopes remain quite undeveloped. Ambu® has developed single-use broncoscopes, rhinolaryngoscopes and duodenoscopes. Recently, they released a single-use cystoscope. In this study, we performed a benchtop and initial clinical assessment of the Ambu® aScope™ (4) Cysto single-use cystoscope. Methods Ten new, never-used Ambu® aScope™ (4) Cysto single-use cystoscopes were assessed for optical performance, maximal tip flexion and irrigation flow rate with empty working channel, 365μm laser fiber, 0.035in hydrophilic-tipped wire, 1.9Fr nitinol basket and a 1.8mm flexible stent grasper. All cystoscopes were then fully flexed 25 times in each direction, and maximal flexion angles were re-measured with and without instruments. Optical resolution, distortion, and depth of field was measured and compared to our reusable digital flexible cystoscopes. Assessment of clinical use was performed for inpatient bedside procedures using a Likert feedback survey and the NASA Task-Load-Index. Results Maximal upward flexion exceeded 200○ and 160○ for all working instruments in upward and downward flexion. Downward flexion demonstrated different flexion between instrument groups in pre- and post-cycling (p<0.001). There was no clinical difference between the pre- or post-cycling flexion. Flow rate decreased with increasing working instrument size (p<0.001). The Olympus HD cystoscope resolution was superior at 3mm and 5mm distance, but not at other distances. The Ambu® scope was superior to the Olympus SD scope at all distances except 3mm. The aScope™ (4) Cysto had higher Likert scale survey scores for clinical use. Conclusions The new Ambu® single-use cystoscope demonstrates good flexion across instruments and comparable optics to reusable cystoscopes. Additionally, initial inpatient bedside use of the aScope™ (4) Cysto and Monitor system compares favorably to the Olympus reusable cystoscope. Further testing in clinical scenarios such as hematuria, urothelial carcinoma and operative endoscopy is warranted.
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Affiliation(s)
- Patrick Whelan
- Duke University Medical Center, 22957, Surgery, Urology, Durham, North Carolina, United States;
| | - Christopher Kim
- Duke University Medical Center, 22957, Surgery, Urology, Durham, North Carolina, United States;
| | - Christian Tabib
- Duke University Medical Center, 22957, Surgery, Urology, Durham, North Carolina, United States;
| | - Glenn M Preminger
- Duke University Medical Center, 22957, Surgery, Urology, Durham, North Carolina, United States;
| | - Michael Eric Lipkin
- Duke University Medical Center, 22957, Surgery, Urology, Durham, North Carolina, United States;
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12
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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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Patil A, Agrawal S, Singh A, Ganpule A, Sabnis R, Desai M. A Single-Center Prospective Comparative Study of Two Single-Use Flexible Ureteroscopes: LithoVue (Boston Scientific, USA) and Uscope PU3022a (Zhuhai Pusen, China). J Endourol 2021; 35:274-278. [PMID: 32967450 DOI: 10.1089/end.2020.0409] [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: 01/03/2023] Open
Abstract
Introduction and Objective: Single-use flexible ureteroscopes have the benefit of decreasing infection transmission, avoiding sterilization need, and no maintenance cost. Primary objective was to compare in vivo performance and surgical outcomes with two single-use ureteroscopes: LithoVue (Boston Scientific, USA) and Uscope PU3022a (Zhuhai Pusen, China) with secondary objective being to compare in vivo vision by independent endourologist blinded to ureteroscope manufacturer. Materials and Methods: Fifty patients undergoing retrograde intrarenal surgery with <2 cm renal stones were prospectively allocated: Group 1 (25 patients) for LithoVue and group 2 (25 patients) for Uscope. Pre-, intra-, and postoperative parameters were evaluated. Vision of both ureteroscopes with and without accessory was evaluated by an independent endourologist, blinded to the make of the ureteroscope. Stone clearance was assessed with kidney, ureter, and bladder radiograph (KUB) and ultrasonography KUB at 1 month. Student's t-test for quantitative and chi-square for categorical data was used. Results: Pre- and intraoperative parameters such as need for ureteral dilatation (p > 0.05), ureteral access-sheath size (p = 0.78), accessibility to pelvicaliceal system (p > 0.05), and maneuverability (p > 0.05) were comparable in both groups. Lower-pole access was possible in all cases of LithoVue and slightly difficult in three cases of Uscope (p > 0.5). Intraoperative vision was hazy in four cases of LithoVue and eight cases of Uscope (p = 0.32) during lasing along with three cases of Uscope with accessory (p = 0.24). Blinded endourologist reported more cases of hazy vision with or without accessory or lasing in Uscope arm (p > 0.05). One device had malfunction in LithoVue arm. Complete stone clearance was achieved in all cases at 1 month. Conclusions: We conclude that performance of these two single-use ureteroscopes, LithoVue and Uscope, is comparable in clinical settings with similar clinical outcomes and complications.
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Affiliation(s)
- Abhijit Patil
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Shashank Agrawal
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Abhishek Singh
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Arvind Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Ravindra Sabnis
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Mahesh Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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14
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Reitblat C, Bain PA, Porter ME, Bernstein DN, Feeley TW, Graefen M, Iyer S, Resnick MJ, Stimson CJ, Trinh QD, Gershman B. Value-Based Healthcare in Urology: A Collaborative Review. Eur Urol 2021; 79:571-585. [PMID: 33413970 DOI: 10.1016/j.eururo.2020.12.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/02/2020] [Indexed: 11/15/2022]
Abstract
CONTEXT In response to growing concerns over rising costs and major variation in quality, improving value for patients has been proposed as a fundamentally new strategy for how healthcare should be delivered, measured, and remunerated. OBJECTIVE To systematically review the literature regarding the implementation and impact of value-based healthcare in urology. EVIDENCE ACQUISITION A systematic review was performed to identify studies that described the implementation of one or more elements of value-based healthcare in urologic settings and in which the associated change in healthcare value had been measured. Twenty-two publications were selected for inclusion. EVIDENCE SYNTHESIS Reorganization of urologic care around medical conditions was associated with increased use of guidelines-compliant care for men with prostate cancer, and improved outcomes for patients with lower urinary tract symptoms. Measuring outcomes for every patient was associated with improved prostate cancer outcomes, while the measurement of costs using time-driven activity-based costing was associated with reduced resource utilization in a pediatric multidisciplinary clinic. Centralization of urologic cancer care in the UK, Denmark, and Canada was associated with overall improved outcomes, although systems integration in the USA yielded mixed results among urologic cancer patients. No studies have yet examined bundled payments for episodes of care, expanding the geographic reach for centers of excellence, or building enabling information technology platforms. CONCLUSIONS Few studies have critically assessed the actual or simulated implementation of value-based healthcare in urology, but the available literature suggests promising early results. In order to effectively redesign care, there is a need for further research to both evaluate the potential results of proposed value-based healthcare interventions and measure their effects where already implemented. PATIENT SUMMARY While few studies have evaluated the implementation of value-based healthcare in urology, the available literature suggests promising early results.
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Affiliation(s)
- Chanan Reitblat
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard Business School, Boston, MA, USA
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Michael E Porter
- Harvard Business School, Boston, MA, USA; Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA
| | - David N Bernstein
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA; Harvard Combined Orthopedic Residency Program (HCORP), Massachusetts General Hospital, Boston, MA, USA
| | - Thomas W Feeley
- Harvard Business School, Boston, MA, USA; Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA
| | - Markus Graefen
- Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Matthew J Resnick
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA; Embold Health, Nashville, TN, USA
| | - C J Stimson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quoc-Dien Trinh
- Harvard Medical School, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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15
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Whelan P, Terry RS, Qi R, Ketterman B, Preminger GM, Lipkin ME. Benchtop Assessment of a New Single-Use Flexible Ureteroscope. J Endourol 2020; 35:755-760. [PMID: 33207957 DOI: 10.1089/end.2020.0836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Single-use flexible ureteroscopes are an increasingly popular alternative to reusable ureteroscopes. In this study, we performed a benchtop examination of the physical and optical properties of the new Dornier Axis™ (Webling, Germany) single-use ureteroscope. Methods: Ten new, never-used Dornier Axis ureteroscopes were assessed for optical performance, maximal tip deflection, and irrigation flow rate with an empty working channel and with insertion of 200 and 365 μm laser fibers, and a 1.9F nitinol basket. All ureteroscopes were then fully deflected 100 times in each direction, and maximal deflection angles were re-measured with and without instruments in the working channel. All measurements were performed in duplicate. In vitro optical testing for resolution, image distortion, and depth of field was performed and compared vs the LithoVue™ (Boston Scientific, Marlborough, MA) single-use ureteroscope. Statistical analyses using paired Wilcoxon rank-sum tests and Kruskal-Wallis multiple-group comparison tests were performed in R. Results: Median maximal deflection angles exceeded 300° in both directions before and after 100 full deflection cycles for all groups except the 365 μm laser fiber group. After 100 deflection cycles, there was no change in the majority of working instruments, except a decrease in upward flexion with an empty channel and 200 μm Moses™ laser fiber, and downward flexion with 200 μm Flexiva™ laser fiber (all <10°). After excluding the 365 μm fiber, there was no difference in multi-group comparison for upward and downward flexion pre- and post-cycling. Median flow rate through an empty channel was 48.0 mL/min, and it decreased significantly with all used instruments (p < 0.001). Compared with the LithoVue, the Axis demonstrated superior resolution at all tested distances and less distortion. Conclusions: The new Dornier Axis single-use ureteroscope demonstrates excellent tip deflection, which remains unchanged after 100 manual flexions in each direction. The Axis also demonstrates superior optical performance compared with the LithoVue in benchtop testing.
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Affiliation(s)
- Patrick Whelan
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Russell S Terry
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Robert Qi
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Brian Ketterman
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Glenn M Preminger
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael E Lipkin
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
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16
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Go JA, Weng CY. Process Mapping and Activity-Based Costing of the Intravitreal Injection Procedure. Curr Eye Res 2020; 46:694-703. [PMID: 32940071 DOI: 10.1080/02713683.2020.1825747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE/AIM OF THE STUDY To quantify the cost of performing an intravitreal injection (IVI) utilizing activity-based costing (ABC), which allocates a cost to each resource involved in a manufacturing process. MATERIALS AND METHODS A prospective, observational cohort study was performed at an urban, multi-specialty ophthalmology practice affiliated with an academic institution. Fourteen patients scheduled for an IVI-only visit with a retina ophthalmologist were observed from clinic entry to exit to create a process map of time and resource utilization. Indirect costs were allocated with ABC and direct costs were estimated based on process map observations, internal accounting records, employee interviews, and nationally-reported metrics. The primary outcome measure was the cost of an IVI procedure in United States dollars. Secondary outcomes included operating income (cost subtracted from revenue) of an IVI and patient-centric time utilization for an IVI. RESULTS The total cost of performing an IVI was $128.28; average direct material, direct labor, and overhead costs were $2.14, $97.88, and $28.26, respectively. Compared to the $104.40 reimbursement set by the Centers for Medicare and Medicaid Services for Current Procedural Terminology code 67028, this results in a negative operating income of -$23.88 (-22.87%). The median clinic resource-utilizing time to complete an IVI was 32:58 minutes (range [19:24-1:28:37]); the greatest bottleneck was physician-driven electronic health record documentation. CONCLUSIONS Our study provides an objective and accurate cost estimate of the IVI procedure and illustrates how ABC may be applied in a clinical context. Our findings suggest that IVIs may currently be undervalued by payors.
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Affiliation(s)
- Jonathan A Go
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Christina Y Weng
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.,Department of Ophthalmology, Ben Taub General Hospital, Harris Health System, Houston, Texas, USA
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17
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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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18
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Beebe SC, Jenkins LC, Posid T, Knudsen BE, Sourial MW. Single-Use Grasper Integrated Flexible Cystoscope for Stent Removal: A Micro-Costing Analysis-Based Comparison. J Endourol 2020; 34:816-820. [DOI: 10.1089/end.2020.0144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sarah C. Beebe
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lawrence C. Jenkins
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tasha Posid
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bodo E. Knudsen
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael W. Sourial
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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19
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Curlin J, Herman CK. Current State of Surgical Lighting. Surg J (N Y) 2020; 6:e87-e97. [PMID: 32577527 PMCID: PMC7305019 DOI: 10.1055/s-0040-1710529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/24/2020] [Indexed: 11/09/2022] Open
Abstract
Surgical performance in the operating room (OR) is supported by effective illumination, which mitigates the inherent environmental, operational, and visual challenges associated with surgery. Three critical components are essential to optimize operating light as illumination: (1) centering on the surgeon's immediate field, (2) illuminating a wide or narrow field with high-intensity light, and (3) penetrating into a cavity or under a flap. Furthermore, optimal surgical illumination reduces shadow, glare, and artifact in visualization of the surgical site. However, achieving these principles is more complex than at first glance, requiring a detailed examination of the variables that comprise surgical illumination. In brief, efficacious surgical illumination combines sufficient ambient light with the ability to apply focused light at specific operative stages and angles. But, brighter is not always merely better; rather, a nuanced approach, cognizant of the challenges inherent in the OR theater, can provide for a thoughtful exploration of how surgical illumination can be utilized to the best of its ability, ensuring a safe and smooth surgery for all.
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Affiliation(s)
- Jahnavi Curlin
- Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Charles K. Herman
- Department of Surgery, Department of Surgery, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
- Division of Plastic Surgery, Division of Plastic Surgery, Lehigh Valley Health Network, Lehigh Valley Hospital-Pocono, East Stroudsburg, Pennsylvania
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20
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21
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Maskal S, Jain R, Fedrigon D, Rose E, Monga M, Sivalingam S. The cost of operating room delays in an endourology center. Can Urol Assoc J 2020; 14:E304-E308. [PMID: 32017697 DOI: 10.5489/cuaj.6099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study sought to characterize delays and estimate resulting costs during nephrolithiasis surgery. METHODS Independent observers documented delays during ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) procedures. Fifty index cases over a period of three months was considered sufficient to observe the generalizable trends. Operating room staff, excluding the surgeons, were blinded. Time-related metrics and delays preventing case progression were recorded using a smartphone-accessible data-collection instrument. Delays were categorized as: 1) missing equipment; 2) missing personnel; 3) equipment malfunction; or 4) delay due to case complexity. The first two categories were regarded as preventable and the latter two non-preventable. RESULTS Forty URS and 18 PCNL cases were included. There was a total of 56 delays in 35 (65%) cases. Twelve (67%) PCNLs and 23 (58%) URSs had delays (p=0.57). The mean cumulative delay per case was 3.5±3.2 minutes. Pre-start delays (n=17) were 4.5±3.5 minutes on average while intraoperative delays (n=39) were 3.1±2.9 minutes (p=0.167). Delays were evenly spread among the four categories. Thirty-one (55%) delays were preventable (mean 3.7±3.2 minutes) while 25 (45%) were non-preventable (mean 3.2±3.2 minutes) (p=0.58). This translates to $137 per case in preventable costs. CONCLUSIONS Preventable operative delays are encountered frequently in nephrolithiasis surgery, translating to significant additional charges and costs. We demonstrate a rationale for the development of improved communication and workflow protocols to increase efficiency in endourological surgeries. Key limitations are the observational nature of the study and sample size.
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Affiliation(s)
- Sara Maskal
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Rajat Jain
- Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, OH, United States
| | - Donald Fedrigon
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Emily Rose
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Manoj Monga
- Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, OH, United States
| | - Sri Sivalingam
- Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, OH, United States
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22
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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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23
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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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McClintock TR, Shah MA, Chang SL, Haleblian GE. Time-Driven Activity-Based Costing in Urologic Surgery Cycles of Care. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:768-771. [PMID: 31277822 DOI: 10.1016/j.jval.2019.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/31/2018] [Accepted: 01/10/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Tyler R McClintock
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George E Haleblian
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Abstract
A PubMed search using the terms "single use" and "ureteroscope" was performed to identify published studies on this topic. In addition, the abstracts of the annual meeting of the World Congress of Endourology and the American Urologic Association since 2010 were reviewed. Here we present a review of published studies on single-use ureteroscopes.
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Affiliation(s)
- Brooke Moore
- Department of Urology, Massachusetts General Hospital, 55 Fruit Street, GRB 1102, Boston, MA 02114, USA
| | - Silvia Proietti
- Department of Urology, IRCCS San Raffaele Hospital, Ville Turro Division, Milan, Italy
| | - Guido Giusti
- Department of Urology, IRCCS San Raffaele Hospital, Ville Turro Division, Milan, Italy
| | - Brian H Eisner
- Department of Urology, Massachusetts General Hospital, 55 Fruit Street, GRB 1102, Boston, MA 02114, USA.
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Bayne DB, Chi TL. Assessing Cost-Effectiveness of New Technologies in Stone Management. Urol Clin North Am 2019; 46:303-313. [PMID: 30961862 DOI: 10.1016/j.ucl.2018.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Diagnosis, treatment, and follow-up are all influential in determining the overall cost to the health care system for kidney stones. New innovations in the field of nephrolithiasis have been abundant, including disposable ureteroscopes, ultrasound-guided approaches to percutaneous nephrolithotomy, and advanced laser lithotripters. Identifying cost-effective treatment strategies encourages practitioners to be thoughtful about providing value-based high-quality care and remains on important principle in the treatment of urinary stone disease.
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Affiliation(s)
- David B Bayne
- Urology, University of California San Francisco, San Francisco, CA, USA.
| | - Thomas L Chi
- Urology, University of California San Francisco, San Francisco, CA, USA
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Taguchi K, Usawachintachit M, Tzou DT, Sherer BA, Metzler I, Isaacson D, Stoller ML, Chi T. Micro-Costing Analysis Demonstrates Comparable Costs for LithoVue Compared to Reusable Flexible Fiberoptic Ureteroscopes. J Endourol 2018; 32:267-273. [PMID: 29239227 DOI: 10.1089/end.2017.0523] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Reusable ureteroscope durability and need for repair are significant sources of expense and inefficiency for patients and urologists. Utilization of LithoVue™, a disposable flexible digital ureteroscope, may address some of these concerns. To identify its economic impact on clinical care, we performed a micro-cost comparison between flexible reusable fiberoptic ureteroscopes (URF-P6™) and LithoVue. PATIENTS AND METHODS For this prospective, single-center micro-costing study, all consecutive ureteroscopies performed during 1 week each in July and August 2016 utilized either URF-P6 or LithoVue ureteroscopes respectively. Workflow data were collected, including intraoperative events, postoperative reprocessing cycle timing, consumables usage, and ureteroscope cost data. RESULTS Intraoperative data analysis showed mean total operating room time for URF-P6 and LithoVue cases were 93.4 ± 32.3 and 73.6 ± 17.4 minutes, respectively (p = 0.093). Mean cost of operating room usage per case was calculated at $1618.72 ± 441.39 for URF-P6 and $1348.64 ± 237.40 for LithoVue based on institutional cost rates exclusive of disposables. Postoperative data analysis revealed costs of $107.27 for labor and consumables during reprocessing for URF-P6 cases. The costs of ureteroscope repair and capital acquisition for each URF-P6 case were $957.71 and $116.02, respectively. The total ureteroscope cost per case for URF-P6 and LithoVue were $2799.72 and $2852.29, respectively. CONCLUSIONS Micro-cost analysis revealed that the cost of LithoVue acquisition is higher per case compared to reusable fiberoptic ureteroscopes, but savings are realized in labor, consumables, and repair. When accounting for these factors, the total cost per case utilizing these two ureteroscopes were comparable.
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Affiliation(s)
- Kazumi Taguchi
- 1 Department of Urology, University of California , San Francisco, San Francisco, California.,2 Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences , Nagoya, Japan
| | - Manint Usawachintachit
- 1 Department of Urology, University of California , San Francisco, San Francisco, California.,3 Division of Urology, Faculty of Medicine, Chulalongkorn University , King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - David T Tzou
- 1 Department of Urology, University of California , San Francisco, San Francisco, California
| | - Benjamin A Sherer
- 1 Department of Urology, University of California , San Francisco, San Francisco, California
| | - Ian Metzler
- 1 Department of Urology, University of California , San Francisco, San Francisco, California
| | - Dylan Isaacson
- 1 Department of Urology, University of California , San Francisco, San Francisco, California
| | - Marshall L Stoller
- 1 Department of Urology, University of California , San Francisco, San Francisco, California
| | - Thomas Chi
- 1 Department of Urology, University of California , San Francisco, San Francisco, California
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