The Cost-Effectiveness of Treatment Modalities for Ureteral Stones

Hybrid flexible ureteroscopy strategy in the management of renal stones - a narrative review

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.

Single-use flexible ureteropyeloscopy: a systematic review

PURPOSE

Data assessing the effectiveness of single-use flexible ureteropyeloscopy (FURS) are limited. This study evaluates and compares single-use FURS with conventional reusable FURS.

METHODS

A systematic search using electronic databases (Pubmed and Embase) was performed for studies evaluating single-use FURS in the setting of urinary tract stone disease. Outcome measures included a comparative evaluation of their mechanical, optical and clinical outcomes.

RESULTS

Eleven studies on 466 patients met inclusion criteria. In vitro comparative data were available on three single-use flexible ureteropyeloscopes (LithoVue™, Polyscope™ and SemiFlex™) and clinical data were available on two (LithoVue™ and Polyscope™). The overall stone-free rate and complication rate associated with single-use FURS was 87 ± 15% and 9.3 ± 9%, respectively. There were no significant differences in procedure duration, stone size, stone clearance and complication rates when single-use FURS and reusable FURS were compared (duration: 73 ± 27 versus 74 ± 13 min, p = 0.99; stone size: 1.36 ± 0.2 versus 1.34 ± 0.18 cm, p = 0.93; stone-free rate: 77.8 ± 18 versus 68.5 ± 33%, p = 0.76; complication rate 15.3 ± 10.6 versus 15 ± 1.6%, p = 0.3).

CONCLUSIONS

Single-use FURS demonstrates comparable efficacy with reusable FURS in treating renal calculi. Further studies on clinical efficacy and cost are needed to determine whether single-use FURS will reliably replace its reusable counterpart.