1
|
Jing Q, Liu F, Yuan X, Zhang X, Cao X. Clinical comparative study of single-use and reusable digital flexible ureteroscopy for the treatment of lower pole stones: a retrospective case-controlled study. BMC Urol 2024; 24:149. [PMID: 39026274 PMCID: PMC11256421 DOI: 10.1186/s12894-024-01541-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 07/10/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVES To compare the clinical efficacy and safety of single-use and reusable digital flexible ureteroscopy for the treatment of lower pole stones. METHODS We enrolled 135 patients underwent reusable flexible ureteroscopy (FURS) and 78 patients underwent single-use digital FURS. Demographic, clinical variables, anatomical parameters of the lower calyx and perioperative indicators were compared in the two groups. RESULTS Thirty-six patients in the infundibuloureter angle (IPA) < 45° subgroup had a mini-percutaneous nephrolithotomy (mini-PCNL), including 25 patients in the reusable FURS group and 11 patients in the single-use FURS group. The demographic and clinical variables in the two FURS groups were comparable. There was no statistical difference in the success rate of stone searching (P > 0.05). In terms of the success rate of lithotripsy, there was also no statistical difference in the IPA ≥ 45° subgroup (P > 0.05), whereas single-use FURS was superior in the IPA < 45° subgroup (χ2 = 6.513, P = 0.011). The length of the working fiber in the reusable FURS and single-use FURS groups was 3.20 ± 0.68 mm and 1.75 ± 0.47 mm, respectively (t = 18.297, P < 0.05). The use of a stone basket in the reusable FURS (31/135, 23.0%) was significantly higher than that in the single-use FURS (8/78, 10.3%) (χ2 = 5.336, P = 0.021). Compared with the reusable FURS group, the single-use FURS group had shorter operation times (P < 0.05) and higher stone-free rate (SFR) (χ2 = 4.230, P = 0.040). There was no statistical difference in the intraoperative transfer of mini-PCNL and postoperative complications between the two groups (P > 0.05). CONCLUSIONS Single-use and reusable FURS are alternative methods for removal of lower pole stones (i.e., 2 cm or less). Single-use FURS has a high success rate of lithotripsy, shorter operation time, and high stone-free rate.
Collapse
Affiliation(s)
- Qiang Jing
- Department of Urology, First Hospital of Shanxi Medical University, No. 85, Jiefang South Road, Taiyuan, Shanxi, 030001, China
| | - Fan Liu
- Department of Urology, First Hospital of Shanxi Medical University, No. 85, Jiefang South Road, Taiyuan, Shanxi, 030001, China
| | - Xiaobin Yuan
- Department of Urology, First Hospital of Shanxi Medical University, No. 85, Jiefang South Road, Taiyuan, Shanxi, 030001, China
| | - Xuhui Zhang
- Department of Urology, First Hospital of Shanxi Medical University, No. 85, Jiefang South Road, Taiyuan, Shanxi, 030001, China.
| | - Xiaoming Cao
- Department of Urology, First Hospital of Shanxi Medical University, No. 85, Jiefang South Road, Taiyuan, Shanxi, 030001, China
| |
Collapse
|
2
|
Salka B, Bahaee J, DiBianco JM, Plott J, Ghani KR. Single-use flexible ureteroscopes: practice patterns, attitudes, and preferences for next-generation concepts. Front Surg 2024; 11:1419682. [PMID: 39027916 PMCID: PMC11254690 DOI: 10.3389/fsurg.2024.1419682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/10/2024] [Indexed: 07/20/2024] Open
Abstract
Background Single use flexible ureteroscopes (su-fURS) have emerged as an alternative to reusable flexible ureteroscopes (r-fURS) for the management of upper urinary tract calculi. However, little is known about urologist usage and attitudes about this technology. Through a worldwide survey of endourologists, we assessed practice patterns and preferences for su-fURS. Methods An online questionnaire was sent to Endourology Society members in January 2021. The survey explored current su-fURS practice patterns, reasons for/against adoption, and preferences for next generation models including developments in imaging, intra-renal pressure, heat generation, and suction. Responses were collected through QualtricsXM over a 1-month period from surgeons in North America, Latin America, Europe, Asia, Africa, and Oceania. The study was conducted according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results 208 (13.9%) members responded to the survey. Most respondents (53.8%) performed >100 ureteroscopies per year. 77.9% of all respondents used su-fURS for less than half of all procedures while only 2.4% used su-fURS for every procedure. 26.0% had never used a su-fURS. Overall, usage was not influenced by a surgeon's geographic region, practice environment, or years of experience. Top reasons for not adopting su-fURS were cost (59.1%) and environmental impact (12.5%). The most desired improvements in design were smaller outer shaft size (19.4%), improved optics and vision (15.9%), and wireless connectivity (13.6%). For next generation concepts, the functions most commonly described as essential or important by respondents was the ability to suction fragments (94.3%) while the function most commonly noted as not important or unnecessary was incorporation of a temperature sensor (40.4%). Conclusions su-fURS are not commonly used, even among urologists who perform a high number of fURS. The primary concern for adoption is cost and environmental impact. Suction capability was considered the most important future development.
Collapse
Affiliation(s)
- Bassel Salka
- University of Michigan Medical School, University of Michigan, Ann Arbor, MI, United States
| | - Jamsheed Bahaee
- General Urology and Pelvic Health Center, Cleveland Clinic Akron, Akron, OH, United States
| | | | - Jeff Plott
- Coulter Program, Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Khurshid R. Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
3
|
Kwok JL, De Coninck V, Panthier F, Kamkoum H, Pauchard F, Shrestha A, Gauhar V, Brachlow J, Schmid FA, Poyet C, Eberli D, Traxer O, Keller EX. Illumination matters part IV: blackout and whiteout in flexible ureteroscopy - first report on a phenomenon observed by PEARLS. World J Urol 2024; 42:294. [PMID: 38704777 PMCID: PMC11070394 DOI: 10.1007/s00345-024-04988-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/07/2024] [Indexed: 05/07/2024] Open
Abstract
PURPOSE To date, no study has evaluated effects of varying brightness settings on image quality from flexible ureteroscopes submerged in saline. The aim was to evaluate blackout and whiteout occurrences in an in-vitro kidney calyx model. MATERIAL AND METHODS We evaluated a series of contemporary flexible ureteroscopes including the Storz Flex-Xc and Flex-X2s, Olympus V3 and P7, Pusen 7.5F and 9.2F, as well as OTU WiScope using a 3D-printed enclosed pink in-vitro kidney calyx model submerged in saline. Endoscopic images were captured with ureteroscope tip placed at 5 mm,10 mm and 20 mm distances. The complete range of brightness settings and video capture modes were evaluated for each scope. Distribution of brightness on a grayscale histogram of images was analyzed (scale range 0 to 255). Blackout and whiteout were defined as median histogram ranges from 0 to 35 and 220 to 255, respectively (monitor image too dark or too bright for the human eye, respectively). RESULTS Blackout occurred with the P7, Pusen 7.5F, 9.2F and WiScope at all distances, and V3 at 20 mm - with lowest brightness settings. Whiteout occurred with Flex-X2s, V3 and P7 at 5 mm and 10 mm, as well as with V3 and P7 at 20 mm - mostly with highest brightness settings. The Flex-Xc had neither blackout nor whiteout at all settings and distances. CONCLUSION Blackout or whiteout of images is an undesirable property that was found for several scopes, possibly impacting diagnostic and therapeutic purposes during ureteroscopy. These observations form a guide to impact a urologist's choice of instruments and settings.
Collapse
Affiliation(s)
- Jia-Lun Kwok
- Department of Urology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vincent De Coninck
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Frédéric Panthier
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC N°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Hatem Kamkoum
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Hamad Medical Corporation, Doha, Qatar
| | - Felipe Pauchard
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Urology Department, Hospital Naval Almirante Nef, 2520000, Viña del Mar, Chile
| | - Anil Shrestha
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, National Academy of Medical Sciences, Bir Hospital and B&B Hospital, Gwarko Lalitpur, Nepal
| | - Vineet Gauhar
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Jan Brachlow
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Zentrum Für Urologie Winterthur, Winterthur, Switzerland
| | - Florian Alexander Schmid
- Department of Urology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
| | - Olivier Traxer
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC N°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France.
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands.
| |
Collapse
|
4
|
Talyshinskii A, Gauhar V, Castellani D, Knoll T, Shah K, Wan SP, Somani BK. Single use flexible ureteroscopes: a review of current technologies and cost effectiveness analysis. Curr Opin Urol 2024; 34:110-115. [PMID: 37962372 DOI: 10.1097/mou.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
PURPOSE OF REVIEW Flexible ureteroscopy (fURS) has evolved into both diagnostic and therapeutic modalities. Our review discusses the cost-effectiveness of single use flexible ureteroscopes (su-fURS) and the use of these instruments in routine urological practice. RECENT FINDINGS There are studies which support the use of su-fURS with an argument of both cost and clinical utility over reusable flexible ureteroscopes (ru-fURS). However, the cost may vary across countries, hence is difficult to compare the results based on the current literature. Perhaps therefore there is a role for hybrid strategy incorporating ru- and su-fURS, where su-fURS are employed in complex endourological cases with a high risk of scope damage or fracture to preserve ru-fURS, with the ability to maintain clinical activity in such an event. SUMMARY While there seems to be some cost advantages with su-fURS with reduced sterilization and maintenance costs, the data supporting it is sparse and limited. This choice of scope would depend on the durability of ru-fURS, procedural volumes, limited availability of sterilization units in some centers and potential risk of infectious complications. It is time that cost-benefit analysis is conducted with defined outcomes for a given healthcare set-up to help with the decision making on the type of scope that best serves their needs.
Collapse
Affiliation(s)
- Ali Talyshinskii
- Department of Urology and Andrology, Astana Medical University, Astana, Kazakhstan
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Thomas Knoll
- Department of Urology, Sindelfingen Medical Center, University of Tuebingen, Germany
| | - Kaushikkumar Shah
- Varun Kidney Hospital and Prasutigarh, Department of Urology, Surat, India
| | - Shaw P Wan
- Apex Urology and Stone Center, Castle Hayne, North Carolina, USA
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| |
Collapse
|
5
|
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.
Collapse
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
| | | |
Collapse
|
6
|
Anderson S, Patterson K, Skolarikos A, Somani B, Bolton DM, Davis NF. Perspectives on technology: to use or to reuse, that is the endoscopic question-a systematic review of single-use endoscopes. BJU Int 2024; 133:14-24. [PMID: 37838621 DOI: 10.1111/bju.16206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
OBJECTIVE To compare clinical outcomes of single-use endoscopes with those of reusable endoscopes to better define their role within urology. METHODS A systematic search of electronic databases was performed. All studies comparing the clinical outcomes of participants undergoing urological procedures with single-use endoscopes to those of participants treated with reusable endoscopes were included. Results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. RESULTS Twenty-one studies in 3943 participants were identified. Six different single-use flexible ureteroscopes and two different single-use flexible cystoscopes were assessed. There were no differences in mean postoperative infection rates (4.0% vs 4.4%; P = 0.87) or overall complication rates (11.5% vs 11.9%; P = 0.88) between single-use and reusable endoscopes. For patients undergoing flexible ureteroscopy there were no differences in operating time (mean difference -0.05 min; P = 0.96), length of hospital stay (LOS; mean difference 0.06 days; P = 0.18) or stone-free rate (SFR; 74% vs 74.3%; P = 0.54) between the single-use and reusable flexible ureteroscope groups. CONCLUSION This study is the largest to compare the clinical outcomes of single-use endoscopes to those of reusable endoscopes within urology, and demonstrated no difference in LOS, complication rate or SFR, with a shorter operating time associated with single-use flexible cystoscope use. It also highlights that the cost efficiency and environmental impact of single-use endoscopes is largely dependent on the caseload and reprocessing facilities available within a given institution. Urologists can therefore feel confident that whether they choose to 'use' or to 'reuse' based on the financial and environmental implications, they can do so without negatively impacting patient outcomes.
Collapse
Affiliation(s)
- Steven Anderson
- Department of Urology, Beaumont Hospital, Dublin, Ireland
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Andreas Skolarikos
- Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Damien M Bolton
- Department of Urology, Austin Hospital, Melbourne, VIC, Australia
| | - Niall F Davis
- Department of Urology, Beaumont Hospital, Dublin, Ireland
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| |
Collapse
|
7
|
Shrestha A, Adhikari B, Panthier F, Baidya S, Gauhar V, Traxer O. Flexible ureteroscopy for lower pole calculus: is it still a challenge? World J Urol 2023; 41:3345-3353. [PMID: 37728745 DOI: 10.1007/s00345-023-04606-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE Flexible ureteroscopy (fURS) is steadily gaining popularity in the management of renal calculi, including those located in the lower pole (LP). Due to difficulty in accessing to the LP of kidney in minority of cases with fURS and reports of lower stone-free rate (SFR), it is still considered as a challenge in selected cases. The purpose of the review was to analyze the various aspects of fURS for LP stones. METHODS An extensive review of the recent literature was done including different factors such as anatomy, preoperative stenting, stone size, flexible scopes, types of lasers, laser fibers, suction, relocation, stone-free rates, and complications. RESULTS The significance of various lower pole anatomical measurements remain a subject of debate and requires standardization. Recent improvements in fURS such as single-use digital scopes with better vision and flexibility, high power laser, thulium fiber laser, smaller laser fiber, and accessories have significantly contributed to make flexible ureteroscopy more effective and safer in the management of LP stone. The utilization of thulium fiber lasers in conjunction with various suction devices is being recognized and can significantly improve SFR. CONCLUSIONS With the significant advancement of various aspects of fURS, this treatment modality has shown remarkable efficacy and gaining widespread acceptance in management of LP kidney stones. These developments have made the fURS of LP stones less challenging.
Collapse
Affiliation(s)
- Anil Shrestha
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
- B&B Hospital, Lalitpur, Nepal.
| | | | | | | | | | | |
Collapse
|
8
|
Kasmani Z, Ravindraanandan M, Mahmalji W. Flexible Ureteroscopy: Global User Experience Using Disposable Devices. Cureus 2023; 15:e46626. [PMID: 37937041 PMCID: PMC10626212 DOI: 10.7759/cureus.46626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 11/09/2023] Open
Abstract
INTRODUCTION Renal stone treatment through flexible ureteroscopy is widely established and successful. Ureteroscopes can broadly be classified into reusable and single-use disposable devices, each with their own advantages. Disposable scopes are cheaper to buy, maintain, and dispose of but may have a greater environmental impact and long-term cost. To establish the collective views of urologists, we conducted a multicentre, global study to demonstrate users' experience with single-use flexible ureteroscopes. Methods: An online nine-question survey was distributed to urologists globally through email and social media platforms. Questions focused on user grade, experience, location, general opinion, advantages, disadvantages, and estimated cost of a single-use flexible ureteroscope. All responses were collated over a three-day period and analysed using descriptive statistics. RESULTS A total of 69 responses were received; the majority of responses were from the UK (75%), and most were consultants (64%). Two-thirds of those surveyed had used a single-use scope on a patient, and 95% of them stated they enjoyed using it, citing excellent vision and reduced need for maintenance. The majority (52%) stated that widespread adoption of disposable scopes was limited due to their prohibitive expense, with an average, sterling-converted responder-estimated cost of £991 (£100-£6000) per reusable scope. CONCLUSION Most urologists enjoyed using disposable scopes, finding them comparable or better than reusable devices. However, the initial cost can be prohibitive in certain centres. The potential environmental impact is a further concern as this remains largely unknown for now. In the meantime, it is likely that stone units will continue to use a combination of single-use and reusable scopes, considering their individual needs and budgets as well as local availability and price.
Collapse
Affiliation(s)
- Zain Kasmani
- Urology, Gloucestershire Hospitals NHS Trust, Cheltenham, GBR
| | | | | |
Collapse
|
9
|
Zhang F, Xu J, Liang H. Single-use flexible ureteroscope provides an alternative treatment for upper urinary calculi: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e34829. [PMID: 37682159 PMCID: PMC10489268 DOI: 10.1097/md.0000000000034829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/28/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the efficacy and safety of single-use flexible ureteroscope and reusable flexible ureteroscope for upper urinary calculi. METHODS We conducted a meta-analysis that had a comprehensive search in PubMed, Embase, Cochrane Library, Web of Science, and WanFang databases from 2000/01/01 to 2023/06/01 for available randomized controlled trials. "Ureteroscopes," "Flexible Ureteroscope," "Single-use," and "Upper Urinary Calculi" were used as the major keywords for the search. Review Manager 5.0 and STATA 12.0 were used for calculation and statistical analysis. RESULTS A total of 9 randomized controlled trials comprising 1293 participants were included in our meta-analysis. Single use-FURS had better results in stone-free rate (relative risk: 1.08, 95% confidence interval: [1.02, 1.15], P = .02) and postoperative infection (relative risk: 0.41, 95% confidence interval: [0.23, 0.72], P = .002). Operative time, hemoglobin decline, postoperative serum creatinine, postoperative hospital stay, and overall complication after surgery showed no significant differences between the 2 procedures (P > .05). CONCLUSION Single-use flexible ureteroscope provides a valuable alternative to reusable flexible ureteroscope in upper urinary calculi with its better visual field performance and manipulation, opening a new technological revolution for kidney stone treatment.
Collapse
Affiliation(s)
- Fulin Zhang
- Department of Urology, People’s Hospital of Longhua, Southern Medical University, Shenzhen, China
| | - Jinbin Xu
- Department of Urology, Guangzhou, China
| | - Hui Liang
- Department of Urology, People’s Hospital of Longhua, Southern Medical University, Shenzhen, China
| |
Collapse
|
10
|
Comparison of Flexible Ureteroscope Performance between Reusable and Single-Use Models. J Clin Med 2023; 12:jcm12031093. [PMID: 36769740 PMCID: PMC9917814 DOI: 10.3390/jcm12031093] [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: 01/02/2023] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Single-use flexible ureteroscopes for urinary retention have been developed in recent years as an alternative to reusable ureteroscopes in order to eliminate the risk of cross-infections and to solve the primary limitations of traditional reusable flexible ureteroscopes for urinary retention. METHODS In this study, we evaluated and contrasted three of the most recent types of flexible ureteroscopes, including two digital reusable versions (Olympus URF-V and Olympus URF-V2) and one single-use model (Pusen Medi-calUscope UE3022), in both ex vivo and in vivo scenarios. The influence of a variety of instruments on the flow of irrigation and its deflection was investigated ex vivo. In the in vivo investigation, a total of 40 patients were treated with retrograde fURS utilizing URF-V, 20 patients were treated with URF-V2, and 20 patients were treated with single-use fURS. The visibility and maneuverability of each fURS were evaluated by the same urologist during the procedures, and the results were compared. RESULTS Intraoperatively, we compared the image quality of reusable (URF-V and URF-V2) and single-use fURS USCOPE UE3022 cameras and found that there was no statistically significant difference between the two types of camera. The score for maneuverability was the same (4.2) regardless of whether we used the UscopeUE3022 or the URF-V2, but it was significantly lower (3.8, p = 0.03) when we utilized the URF-V. Irrigation was about the same when utilizing reused scopes, whereas employing a single-use scope was more than fifty percent more effective. CONCLUSIONS The findings of our research indicate that reusable and single-use fURs have visibility and maneuverability characteristics that are at least comparable to one another. The possibilities of the single-use type in terms of irrigation flow and deflection are superior.
Collapse
|
11
|
Bragaru M, Multescu R, Georgescu D, Bulai C, Ene C, Popescu R, Geavlete P, Geavlete B. Single-use versus conventional reusable flexible ureteroscopes - an evaluation of the functional parameters. J Med Life 2023; 16:10-15. [PMID: 36873117 PMCID: PMC9979166 DOI: 10.25122/jml-2022-0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/27/2022] [Indexed: 03/07/2023] Open
Abstract
The purpose of single-use flexible ureteroscopes (su-fURS) was to overcome the limitations of conventional reusable ureteroscopes in terms of maneuverability and maintenance. We aimed to perform a systematic literature review on available su-fURS performance versus conventional reusable fURS focusing on clinical data. A systematic research using Pubmed was performed evaluating single-use fURS and reusable fURS in urinary tract stone disease, including prospective assessments and case series. This review aimed to provide an overview of single-use and disposable flexible ureteroscopes and to examine and compare their capabilities (deflection, irrigation, optical properties). We included 11 studies, where the single-use fURS were compared to the reusable fURS. The studies with single-use ureteroscopes included data on LithoVue (Boston Scientific), The Uscope UE3022 (Pusen, Zhuhai, China), NeoFlex-Flexible, (Neoscope Inc San Jose, CA), 23 YC-FR-A (Shaogang). For reusable ureteroscopes, data were included on three models, two digital (Karl Storz Flex-XC and Olympus URF-Vo) and one fiber optic (Wolf-Cobra). There were no significant differences in stone-free rate, procedure duration, or functional capabilities between single-use fURS and reusable fURS. The systematic literature review analyzed operative time, functional capabilities, stone-free rates, and postoperative complications of the ureteroscopes, and a special chapter about renal abnormalities to emphasize that they are a good choice having a high proportion of stone-free rates and few risks, particularly in treating difficult-to-access calculi. Single-use fURS demonstrate a comparable efficacy with reusable fURS in resolving renal lithiasis. Further studies on clinical efficacy are needed to determine whether single-use fURS will reliably replace its reusable counterpart.
Collapse
Affiliation(s)
- Marius Bragaru
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Razvan Multescu
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Dragos Georgescu
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Cătălin Bulai
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Cosmin Ene
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Razvan Popescu
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Petrişor Geavlete
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Bogdan Geavlete
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| |
Collapse
|
12
|
Single-use flexible ureteroscopes: Comparative in vitro analysis of four scopes. Asian J Urol 2023; 10:64-69. [PMID: 36721687 PMCID: PMC9875117 DOI: 10.1016/j.ajur.2022.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 03/22/2021] [Accepted: 08/23/2021] [Indexed: 02/03/2023] Open
Abstract
Objective Single-use flexible ureteroscopes (fURSs) have recently been introduced by different companies. Goal of this in-vitro study was to compare four fURSs. Methods We performed in vitro analysis of Uscope 7.5 Fr and Uscope 9.5 Fr (Pusen Ltd., Zhuhai, China), LithoVue 9.5 Fr (LithoVue™, Boston Scientific, MA, USA), and Indoscope 9.5 Fr (Bioradmedisys™, Pune, India). Optical characteristics (image resolution, color representation, and luminosity) were compared at various distances of 10 mm, 20 mm, and 50 mm. Deflection and irrigation were evaluated with and without accessories. Results Color perception was comparable for all scopes at 10 mm (p<0.05), while Lithovue 9.5 Fr was comparable with Indoscope 9.5 Fr at the distances of 20 mm and 50 mm. Both scopes were statistically better than both Uscopes at the distances of 20 mm and 50 mm. Image resolution powers were comparable amongst all fURSs at the distances of 10 mm and 20 mm (3.56 line pairs per millimeter [lp/mm]). However, Indoscope (3.56 lp/mm) was superior to LithoVue and Uscope scopes (3.17 lp/mm) at the distance of 50 mm. Luminosity at the distance of 10 mm was comparable for LithoVue and Uscope 9.5 Fr. However, at the distances of 20 mm and 50 mm, LithoVue had the highest luminosity while Uscope 7.5 Fr had the lowest one. Indoscope had lower luminosity than other 9.5 Fr scopes at all distances. With empty working channel and 200 μm laser fiber, Indoscope had the maximum deflection (285°). With basket, Uscope 7.5 Fr had the maximum loss of deflection (30°) while Indoscope had no deflection loss. With empty working channel, all scopes had comparable irrigation flow rates in both deflected and undeflected state. Similarly, with 200 μm laser or basket, irrigation flow rates were comparable in all scopes. Conclusion Color representation was equivalent for Indoscope and LithoVue, while being better than Uscope 7.5 Fr and Uscope 9.5 Fr. Image resolution was comparable in all scopes at the distances of 10 mm and 20 mm. Beyond the distance of 10 mm, luminosity of LithoVue was the highest and that of Uscope 7.5 Fr was the lowest. Deflection loss was the minimum with Indoscope and the maximum with 7.5 Fr Uscope. Under all scenarios, irrigation flow rates were comparable in all scopes.
Collapse
|
13
|
Tzelves L, Geraghty RM, Hughes T, Juliebø-Jones P, Somani BK. Innovations in Kidney Stone Removal. Res Rep Urol 2023; 15:131-139. [PMID: 37069942 PMCID: PMC10105588 DOI: 10.2147/rru.s386844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/05/2023] [Indexed: 04/19/2023] Open
Abstract
Urolithiasis is a common clinical condition, and surgical treatment is performed with different minimally invasive procedures, such as ureteroscopy, shockwave lithotripsy and percutaneous nephrolithotomy. Although the transition from open surgery to endourological procedures to treat this condition has been a paradigm shift, ongoing technological advancements have permitted further improvement of clinical outcomes with the development of modern equipment. Such innovations in kidney stone removal are new lasers, modern ureteroscopes, development of applications and training systems utilizing three-dimensional models, artificial intelligence and virtual reality, implementation of robotic systems, sheaths connected to vacuum devices and new types of lithotripters. Innovations in kidney stone removal have led to an exciting new era of endourological options for patients and clinicians alike.
Collapse
Affiliation(s)
- Lazaros Tzelves
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Thomas Hughes
- Department of Urology, Warwick Hospital, Warwick, UK
| | | | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
- Correspondence: Bhaskar K Somani, Department of Urology, University Hospital Southampton NHS Trust, 19 Tremona Road, Southampton, SO535DS, UK, Tel +44-2381206873, Email
| |
Collapse
|
14
|
Jun DY, Cho KS, Jeong JY, Moon YJ, Kang DH, Jung HD, Lee JY. Comparison of Surgical Outcomes between Single-Use and Reusable Flexible Ureteroscopes for Renal Stone Management: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1388. [PMID: 36295549 PMCID: PMC9607009 DOI: 10.3390/medicina58101388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 10/03/2023]
Abstract
Background and Objectives: Disposable flexible ureteroscopes have been widely used because of their cost-effectiveness and higher sterility potential compared with reusable flexible ureteroscopes. This study aimed to compare the surgical outcomes and complication rates in patients who undergo reusable or disposable flexible ureteroscopic stone surgeries (fURS) for urinary stone disease. Materials and Methods: A systematic review and meta-analysis were conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. This systematic review was registered with PROSPERO (CRD42022331291). Clinical trials comparing reusable and disposable fURS for stone disease were found from PubMed, EMBASE, Cochrane Library, and the Web of Science up to March 2022. Participants were patients with upper urinary tract stones; the interventions were reusable or disposable fURS. Outcomes, including stone-free rate, operation time, length of hospital stay, and complication rate, were compared for analysis. Results: Overall, 111 studies were identified, but after removing duplicate studies, 75 studies remained. Thirty-two of these studies were excluded. Of the 43 screened studies, 11 met the eligibility criteria. There was no difference in the stone-free rate (SFR) between disposable and reusable fURS (p = 0.14; OR = 1.36; 95% CI, 0.9 to 2.04). For operation time, no difference was identified between reusable and disposable fURS groups (p = 0.12; MD = -5.31; 95% CI, -12.08 to 1.46). For hospital stay, there was also no difference between the two groups (p = 0.61; MD = -0.03; 95% CI, -0.17 to 0.10). There was no significant difference in complication rate between the two groups (p = 0.85; OR = 0.95; 95% CI, 0.56 to 1.61). Conclusions: There were no differences in the SFR, operation time, length of hospital stay, and complication rate between reusable and disposable fURS. Disposable fURS may be a comparable alternative to reusable fURS.
Collapse
Affiliation(s)
- Dae Young Jun
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Kang Su Cho
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Jae Yong Jeong
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Young Joon Moon
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Dong Hyuk Kang
- Department of Urology, Inha University College of Medicine, Incheon 22212, Korea
| | - Hae Do Jung
- Department of Urology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul 03722, Korea
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Ali AI, Eldakhakhny A, Abdelfadel A, Rohiem MF, Elbadry M, Hassan A. WiScope® single use digital flexible ureteroscope versus reusable flexible ureteroscope for management of renal stones: a prospective randomized study. World J Urol 2022; 40:2323-2330. [PMID: 35895116 DOI: 10.1007/s00345-022-04095-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/07/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To compare the clinical performance and surgical outcomes of the new digital single use flexible ureteroscope (WiScope®) with a reusable digital flexible ureteroscope. PATIENT AND METHODS Our prospective study includes patients with renal stones less than 2 cm who underwent retrograde flexible ureteroscopy and laser lithotripsy. Patients were randomized into two groups: group A included patients who underwent laser lithotripsy using WiScope® Single use digital flexible ureteroscope and group B included patients who underwent laser lithotripsy using reusable flexible ureteroscope. Image quality, deflection, ease of insertion, maneuverability, and overall performance were assessed using either a visual analog or Likert scale. Operative outcomes and complications were collected and analyzed in both groups. RESULTS A total of 242 patients were included in our study. There were 121 patients in the WiScope® group and 121 patients in reusable ureteroscope group. The WiScope® had higher maneuverability (9.3 ± 0.7 vs. 7.2 ± 0.8, P < 0.001) and less limb fatigue but had lower image quality when compared to reusable digital flexible ureteroscope (7.6 ± 0.9 vs. 9.2 ± 0.6, P < 0.001). There were no differences in operative time, complication rates and rates of relook ureteroscopy. CONCLUSIONS The WiScope® single use flexible ureteroscope has comparable outcomes to the reusable flexible ureteroscope with regard to maneuverability, limb fatigue, and deflection. However, it has a lower image quality.
Collapse
Affiliation(s)
- Ahmed I Ali
- Department of Urology, School of Medicine, Minia University Hospital, Minia, 61111, Egypt.
| | - Amr Eldakhakhny
- Department of Urology, School of Medicine, Benha University Hospital, Benha, 61111, Egypt
| | - Abdelsalam Abdelfadel
- Department of Urology, School of Medicine, Minia University Hospital, Minia, 61111, Egypt
| | - Mahmoud F Rohiem
- Department of Urology, Port Said University Hospital, Port Said, 6459, Egypt
| | - Mohamed Elbadry
- Department of Urology, School of Medicine, Minia University Hospital, Minia, 61111, Egypt
| | - Ali Hassan
- Department of Urology, School of Medicine, Minia University Hospital, Minia, 61111, Egypt
| |
Collapse
|
17
|
Clark CS, Gnanappiragasam S, Thomas K, Bultitude M. Cystinuria: An Overview of Challenges and Surgical Management. Front Surg 2022; 9:812226. [PMID: 35784929 PMCID: PMC9243440 DOI: 10.3389/fsurg.2022.812226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
|
18
|
Rindorf DK, Tailly T, Kamphuis GM, Larsen S, Somani BK, Traxer O, Koo K. Repair Rate and Associated Costs of Reusable Flexible Ureteroscopes: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2022; 37:64-72. [PMID: 35128483 PMCID: PMC8810356 DOI: 10.1016/j.euros.2021.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Context The refined mechanics of a flexible ureteroscope (fURS) are vulnerable to damage. Sending the fURS for repair is costly and has driven interest toward estimating the resources used for fURS repairs. Objective To systematically review available literature and to estimate the total weighted repair rate of an fURS and the average repair cost per ureteroscopy. Evidence acquisition A systematic review was conducted by searching the MEDLINE, Embase, Web of Science, and Cochrane Library databases. The average costs of all repairs identified in the included studies were extracted. A random-effect model was used to calculate the pooled total fURS repair rate. The total weighted repair rate and average cost per repair were multiplied to provide an average cost of repair per ureteroscopy procedure. Evidence synthesis We identified 18 studies that fulfilled the inclusion criteria, which included 411 repairs from 5900 investigated ureteroscopy procedures. The calculated weighted repair rate was 6.5% ± 0.745% (95% confidence interval: 5.0–7.9%; I2 = 75.3%), equivalent to 15 ureteroscopy procedures before repair. The average cost per repair was 6808 USD; according to the weighted repair rate of 6.5%, this corresponds to an average repair cost of 441 USD per procedure. Egger’s regression test did not reveal a significant publication bias (p = 0.07). Conclusions This is the first meta-analysis to estimate the repair rate of the fURS used for ureteroscopy. Our analysis demonstrates a repair rate of 6.5%, equivalent to 15 ureteroscopy procedures between fURS repairs and a repair cost of 441 USD per procedure. Ureteroscopy practices should consider fURS breakage rates and repair costs to optimize the use of reusable versus disposable devices. Patient summary We reviewed available literature investigating the repair rate of a flexible ureteroscope (fURS). We found that fURSs are sent for repair after every 15 ureteroscopy procedures, corresponding to 441 USD per procedure in repair cost.
Collapse
|
19
|
Huang F, Zhang X, Cui Y, Zhu Z, Li Y, Chen J, Zeng F, Li Y, Chen Z, Chen H. Single-Use vs. Reusable Digital Flexible Ureteroscope to Treat Upper Urinary Calculi: A Propensity-Score Matching Analysis. Front Surg 2022; 8:778157. [PMID: 35083269 PMCID: PMC8784383 DOI: 10.3389/fsurg.2021.778157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/06/2021] [Indexed: 11/20/2022] Open
Abstract
Objective: The purpose of this research was to compare the treatment outcomes and costs of a single-use and reusable digital flexible ureteroscope for upper urinary calculi. Methods: Four hundred forty patients with reusable digital flexible ureteroscope and 151 patients with single-use flexible digital ureteroscope were included in this study. Through exclusion and inclusion criteria and 1:1 propensity-score matching analysis based on baseline characteristics, ultimately, 238 patients (119:119) were compared in terms of treatment outcomes. The cost analysis was based on the costs of purchase, repair, and reprocessing divided by the number of all procedures in each group (450 procedures with reusable digital flexible ureteroscope and 160 procedures with single-use digital flexible ureteroscope). Results: There was no statistical significance in mean operation time (P = 0.666). The single-use digital flexible ureteroscope group has a shorter mean length of hospital stay than the reusable digital flexible ureteroscope group (P = 0.026). And the two groups have a similar incidence of postoperative complications (P = 0.678). No significant difference was observed in the final stone-free rate (P = 0.599) and the probability of secondary lithotripsy (P = 0.811) between the two groups. After 275 procedures, the total costs of a single-use flexible ureteroscope would exceed the reusable flexible ureteroscope. Conclusion: Our data demonstrated that the single-use digital flexible ureteroscope is an alternative to reusable digital flexible ureteroscopy in terms of surgical efficacy and safety for upper urinary calculi. In terms of the economics of the two types of equipment, institutions should consider their financial situation, the number of FURS procedures, the volume of the patient's calculus, surgeon experience, and local dealerships' annual maintenance contract when making the choice.
Collapse
Affiliation(s)
- Fang Huang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoqiong Zhang
- Department of Transplantation, Xiangya Hospital, Central South University, Changsha, China
| | - Yu Cui
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zewu Zhu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yongchao Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Jinbo Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Feng Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyong Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Hequn Chen
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Meng C, Peng L, Li J, Li Y, Li J, Wu J. Comparison Between Single-Use Flexible Ureteroscope and Reusable Flexible Ureteroscope for Upper Urinary Calculi: A Systematic Review and Meta-Analysis. Front Surg 2021; 8:691170. [PMID: 34722620 PMCID: PMC8548426 DOI: 10.3389/fsurg.2021.691170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/07/2021] [Indexed: 12/23/2022] Open
Abstract
Objective: This article explores the differences in the effectiveness and safety of the treatment of the upper urinary calculi between single-use flexible ureteroscope (su-fURS) and reusable flexible ureteroscope (ru-fURS). Methods: We systematically searched PubMed, Embase, Cochrane Library, Scopus database, and CNKI databases within a period from the date of database establishment to November 2020. Stata 16 was used for calculation and statistical analyses. Results: A total of 1,020 patients were included in the seven studies. The statistical differences were only found in the Clavien–Dindo grade II postoperative complication [odds ratio (OR) 0.47; 95% CI 0.23–0.98; p = 0.04]. No significant statistical differences were observed in operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), and stone-free rate (SFR). Conclusion: Our meta-analysis results demonstrate that su-fURS, compared with ru-fURS, has similar effectiveness and better security for treating upper urinary calculi.
Collapse
Affiliation(s)
- Chunyang Meng
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Lei Peng
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Jinze Li
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Jinming Li
- Department of Urology, The Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Ji Wu
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, China
| |
Collapse
|
22
|
Mourmouris P, Tzelves L, Raptidis G, Berdempes M, Markopoulos T, Dellis G, Siafakas I, Skolarikos A. Comparison of a single-use, digital flexible ureteroscope with a reusable, fiberoptic ureteroscope for management of patients with urolithiasis. Arch Ital Urol Androl 2021; 93:326-329. [PMID: 34839639 DOI: 10.4081/aiua.2021.3.326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 07/25/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Ureteroscopy is one of the commonest procedures performed to manage urolithiasis. Flexible ureteroscopy has been traditionally based on reusable, fiber-optic ureteroscopes. Technology advancements permitted the development of single-use scopes with digital image. The aim of this study is to compare efficacy and safety between a reusable, fiberoptic ureteroscope with a single-use, digital scope. PATIENTS AND METHODS We collected data based on chart review from a prospectively collected database on a tertiary, high-volume hospital in Greece. Baseline, perioperative and postoperative data were gathered and analyzed. Chi-square and Fisher's exact test was used to compare qualitative data and unpaired t-test for continuous data, with a statistical significance set at a = 0.05. RESULTS 40 patients underwent flexible ureteroscopy with a single- use digital scope, while 37 with the reusable scope. The two groups were matched regarding baseline characteristics and stone-related parameters. After data analysis, a shorter operative time in favor of single-use flexible ureteroscope was detected (45 vs 65 min, p = 0.001), while safety was also in favor of this type of scope with a significantly higher immediate stonefree rate (70% vs 43%, p = 0.005). Overall complications did not differ between the two groups, although a lower sepsis rate was detected in patients treated with single-use scope. CONCLUSIONS Our findings indicate that single-use, digital ureteroscopes are a viable alternative for flexible ureteroscopy and management of urolithiasis, especially in centers with deficient facilities for sterilization and ensured funds for more expensive reusable scopes.
Collapse
Affiliation(s)
- Panagiotis Mourmouris
- National and Kapodistrian University of Athens, 2nd University Department of Urology, Sismanoglio Hospital, Athens.
| | - Lazaros Tzelves
- National and Kapodistrian University of Athens, 2nd University Department of Urology, Sismanoglio Hospital, Athens.
| | | | - Marinos Berdempes
- National and Kapodistrian University of Athens, 2nd University Department of Urology, Sismanoglio Hospital, Athens.
| | - Titos Markopoulos
- National and Kapodistrian University of Athens, 2nd University Department of Urology, Sismanoglio Hospital, Athens.
| | | | | | - Andreas Skolarikos
- National and Kapodistrian University of Athens, 2nd University Department of Urology, Sismanoglio Hospital, Athens.
| |
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Van Compernolle D, Veys R, Elshout PJ, Beysens M, Van Haute C, De Groote L, Tailly T. Reusable, Single-Use, or Both: A Cost Efficiency Analysis of Flexible Ureterorenoscopes After 983 Cases. J Endourol 2021; 35:1454-1459. [PMID: 33775101 DOI: 10.1089/end.2021.0006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objectives: To determine which flexible ureterorenoscopy program would be most cost-efficient in our center, a cost efficiency analysis and a formula to assess cost efficiency feasibility of a hybrid model were performed. Methods: Total cost per case of reusable flexible ureterorenoscopes (rfURS) was retrospectively calculated and compared with two single-use flexible ureterorenoscopes (sufURS) marketed. A mathematical formula was developed from our data to identify the necessary increase of use of rfURS (NIU-rfURS) to be cost-efficient in a hybrid system utilizing sufURS for only high-risk-of-breakage cases. Results: In 57 months, 983 procedures were performed using 4 digital rfURS (Flex-XC; Storz), necessitating 45 repairs, with a total repair cost of €256.809. Including the capital investment of €24.000 per scope and €60 per sterilization cycle, the cost per case averaged €419 after 983 cases. Consistently using sufURS would have cost 55% to 127% more (respectively, Uscope PU3022® and Lithovue® at €650 and €950 manufacturer suggested retail price). On a per case analysis, the cost was initially extremely high, but declined to reach a plateau around €480 after ∼400 cases. After 155 or 274 procedures, a rfURS program appeared more cost-efficient than consistently using Lithovue or Uscope PU3022, respectively. Based on our data and formula, if we would hypothetically use Uscope PU3022 or Lithovue for 15% of the cases, the NIU-rfURS is, respectively, 28% or 74% (∼6 or 16 cases). The NIU-rfURS increases exponentially with an increased use of sufURS. Conclusion: Consistently using rfURS is more cost-efficient than the constant use of sufURS after 155 to 274 cases. We describe the first mathematical formula that allows a calculation and feasibility assessment of using both reusable and disposable fURS. To identify whether a hybrid system may be a feasible cost-efficient alternative to a rfURS-only program, any center can calculate the NIU-rfURS by entering center-specific data in the formula.
Collapse
Affiliation(s)
| | - Ralf Veys
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Matthias Beysens
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Carl Van Haute
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Thomas Tailly
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
26
|
Baboudjian M, Gondran-Tellier B, Abdallah R, Tadrist A, Sichez P, Akiki A, Gaillet S, Delaporte V, Karsenty G, Lechevallier E, Boissier R. Single use and reusable flexible ureteroscopies for the treatment of urinary stones: A comparative study of perioperative complications. Prog Urol 2021; 31:368-373. [DOI: 10.1016/j.purol.2020.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/22/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
|
27
|
Ma YC, Jian ZY, Jin X, Li H, Wang KJ. Stone removing efficiency and safety comparison between single use ureteroscope and reusable ureteroscope: a systematic review and meta-analysis. Transl Androl Urol 2021; 10:1627-1636. [PMID: 33968651 PMCID: PMC8100856 DOI: 10.21037/tau-20-1399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Urologists are gradually beginning to use single-use ureteroscopes (sufURSs), despite a lack of high-level evidence as to their efficacy and safety. This systematic review was registered on PROSPERO (no. CRD42020181808). Methods The PubMed, Embase, Web of Science, and Cochrane Library databases were searched for studies published before October 1, 2020. Jadad score tools were used to evaluate the quality of the included randomized controlled trials (RCTs) and the Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included nonrandomized studies. Two researchers independently extracted data according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles. A data synthesis was performed using Stata 15.0. Heterogeneity was mainly evaluated with I2 tests. In addition to funnel plots, Egger's and Begg's tests were used to detect publication bias. A sensitivity analysis was also performed. Stone-free rates and postoperative complications were the 2 primary outcomes; operation-time data were also extracted. Results Six studies (comprising 887 patients) containing the efficacy data and 5 studies (comprising 952 patients) containing the safety data that were finally included in the quantitative analysis. In relation to stone removal, no significant difference was found in terms of efficacy [Mantel-Haenszel statistic (M-H), relative risk (RR): 1.01, 95% confidence interval (CI): 0.96-1.07, P=0.658) or safety (M-H, RR: 1.30, 95% CI: 0.96-1.75, P=0.093) between the sufURS and the reusable flexible ureteroscope (rfURS), and no significant heterogeneity was found. A publication bias was detected in the efficacy comparison; however, the trim-and-fill analysis indicated that the original synthesis results remained stable. Conclusions In relation to stone removal, sufURSs were found to be comparable to rfURS, and no compromising complications were found. However, the results should be treated with caution due to limitations related to the small number of studies included in the analysis.
Collapse
Affiliation(s)
- Yu-Cheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Zhong-Yu Jian
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Xi Jin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Kun-Jie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
Li Y, Chen J, Zhu Z, Zeng H, Zeng F, Chen Z, Yang Z, Cui Y, Chen H, Li Y. Comparison of single-use and reusable flexible ureteroscope for renal stone management: a pooled analysis of 772 patients. Transl Androl Urol 2021; 10:483-493. [PMID: 33532336 PMCID: PMC7844498 DOI: 10.21037/tau-20-1009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Flexible ureteroscopy is a common therapy for patients with renal calculi. In recent years, the prevalence of single-use flexible ureteroscope (FURS) use has been on the rise. Thus, several trials have been conducted to compare the efficacy between single-use and reusable FURS. The aim of this meta-analysis was to systematically assess the effectiveness and safety of single-use vs. reusable FURS in treating renal stones. PubMed, Web of Science, Cochrane Library and EMBASE were researched to identify relevant studies up to September 2019. Article selection was performed through the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The Newcastle-Ottawa Scale was applied to assess the methodological quality of non-randomized controlled trials, and the methodological quality of randomized controlled trials was evaluated using the Jadad scale. A total of five studies with 772 patients were included in the meta-analysis, including two randomized controlled trials, two single-centre prospective studies, and one prospective case-control trial. The pooled results showed that single-use FURS was associated with a higher stone-free rate (SFR) (OR: 1.50; 95% CI, 1.06–2.12; P=0.02) than reusable FURS. A significant difference was noted in operative time, and single-use FURS was associated with a longer operative duration (MD: 7.39 min; 95% CI, 1.75–13.03; P=0.01). No significant difference was noted in perioperative complications (OR: 0.97; 95% CI, 0.56–1.70; P=0.92). Subgroup analysis showed no significant difference in urinary tract infection (OR: 0.80; 95% CI, 0.44–1.46; P=0.46), stent migration (OR: 0.56; 95% CI, 0.19–1.65; P=0.30) or acute kidney injury (OR: 0.76; 95% CI, 0.16–3.57; P=0.73). Single-use FURS is an effective and safe alternative to reusable FURS for the management of renal stones.
Collapse
Affiliation(s)
- Yongchao Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Jinbo Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zewu Zhu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Huimin Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Feng Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyong Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhongqing Yang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yu Cui
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
31
|
Evaluation of a new disposable flexible ureterorenoscope and comparison to an established disposable flexible ureterorenoscope: a prospective, observational study. Int Urol Nephrol 2021; 53:875-881. [PMID: 33386582 DOI: 10.1007/s11255-020-02727-0] [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] [Received: 10/19/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To objectively and subjectively assess the performance and surgical outcomes of the new Innovex EU-scope™ single-use digital flexible ureteroscope (fURS). METHODS A prospective cohort study was carried out (August 2019 to May 2020). The new single-use fURS (Innovex Medical Devices Co. Shanghai, China) was analysed with regard to visibility, manoeuvrability, laser interference and overall performance using a validated Likert scale. Outcomes are compared to the LithoVue™ (Boston Scientific, Marlborough, MA). RESULTS One hundred patients were included in this study. 50 cases underwent retrograde fURS using the Innovex EU-scope™ and 50 with the LithoVue™. There were no differences in the patient demographics data, or operative data between the two groups. The Innovex EU-scope™ scored higher visibility scores compared to the LithoVue™, median 4, interquartile range (IQR) (4-4), vs. 3.5, IQR (3-5), p = 0.5086. Both scopes had similar manoeuvrability scores. The Innovex EU-scope™ scored significantly lower with regard to comfort compared to the LithoVue, median 4 IQR (3-4) vs. 4.5 IQR (4-5), p = 0.0445. Whereas, laser interference, affected the Innovex much less than the LithoVue™. Both scopes scored well for overall performance. The median overall performance score for the Innovex was 4 IQR (4-4) vs. 4 IQR (4-5). CONCLUSIONS This Innovex EU-scope™ has good objective and subjective visibility and manoeuvrability profiles. This single-use flexible ureteroscope may achieve similar clinical outcomes to an established single use instrument.
Collapse
|
32
|
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.
Collapse
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
| |
Collapse
|
33
|
Forbes CM, Lundeen C, Beebe S, Moore JP, Knudsen BE, Humphreys MR, Chew B. Device profile of the LithoVue single-use digital flexible ureteroscope in the removal of kidney stones: overview of safety and efficacy. Expert Rev Med Devices 2020; 17:1257-1264. [PMID: 33307869 DOI: 10.1080/17434440.2020.1848538] [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: 10/22/2022]
Abstract
Introduction: Flexible ureteroscopy is a commonly performed urologic procedure for visualization and treatment of the upper urinary tracts. Traditionally, ureteroscopy has been performed with reusable scopes, which have large initial purchasing costs. LithoVue was the first widely adopted single-use flexible ureteroscope clinically available in 2016 and has caused reevaluation of this paradigm. Areas covered: This review is an objective assessment of the LithoVue single-use ureteroscope based on available studies at the time of publication. The authors searched major databases for papers that included the term 'LithoVue' and included relevant papers. The state of the market, technical specifications, results from clinical studies and cost analyses, and competitors are discussed. Expert opinion: The LithoVue single-use flexible ureteroscope has comparable clinical performance to existing reusable ureteroscopes based on available data. Direct clinical comparisons to competing single-use ureteroscopes, many of which are relatively new, are limited. In numerous pre-clinical studies LithoVue performed favorably compared to available competitors. Cost analyses suggest that benefit of single-use ureteroscopes is institution-specific, and will likely be favorable at a low volume of cases and with high local costs for repairs of reusable scopes.
Collapse
Affiliation(s)
- Connor M Forbes
- Department of Urologic Sciences, University of British Columbia , Vancouver, Canada.,Department of Urology, Vanderbilt University Medical Center , Nashville, TN, USA
| | - Colin Lundeen
- Department of Urologic Sciences, University of British Columbia , Vancouver, Canada
| | - Sarah Beebe
- Department of Urology, Ohio State University Wexner Medical Center , Columbus, Ohio, USA
| | - Jonathan P Moore
- Department of Urology, Mayo Clinic Arizona , Phoenix, Arizona, USA
| | - Bodo E Knudsen
- Department of Urology, Ohio State University Wexner Medical Center , Columbus, Ohio, USA
| | | | - Ben Chew
- Department of Urologic Sciences, University of British Columbia , Vancouver, Canada
| |
Collapse
|
34
|
Hennessey DB. Editorial Comment to Single use versus reusable digital flexible ureteroscopes: A prospective comparative study. Int J Urol 2019; 26:1005-1006. [PMID: 31448434 DOI: 10.1111/iju.14094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|