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Comparison of single-use flexible ureteroscopes with a reusable ureteroscope for the management of paediatric urolithiasis

Published:January 18, 2023DOI:https://doi.org/10.1016/j.jpurol.2023.01.009

      Summary

      Introduction

      To compare the efficacy, side effects, and cost-effectiveness between a single-use digital flexible ureteroscope and a reusable flexible ureteroscope in the treatment of paediatric renal stones.

      Methods

      This analytic, case-control, monocentric study included all patients undergoing flexible ureterosopies for stone treatment. Between April 2016 and February 2019, a reusable (Flex-XC®, Karl Storz) flexible ureteroscope was used (control group), whereas a single-use (Uscope®, PUSEN Medical©) flexible ureteroscope was used in all procedures from March 2019 to April 2021. Clinical and procedural outcomes, operative times, complication rates, hospital stay, and costs per procedure were evaluated.

      Results

      Forty-three cases using a reusable flexible ureteroscope and thirty-nine using a single-use flexible ureteroscope were included in the study. Demographic patient characteristics, stone burden, location and composition, preoperative presence of a double-J stent, procedural outcomes, mean length of postoperative hospital stay, and complications (4.6% versus 5%, p=0.81) were comparable between the two groups. Median operative duration for stone removal was 93 min (20-170) with reusable versus 81 min (55-107) with the single-use scope (p=0.18).
      Scope failure occurred four times with the reusable scope and in no case with the single-use. The total cost per procedure associated with the use of single-use scopes (798 Euros) was lower than a reusable scope (1483.23 Euros).

      Discussion

      Single-use flexible ureteroscopes were created to bypass the problems incurred when reusable scopes were damaged and therefore not available for use in surgical procedures. Single-use flexible ureteroscopes are always immediately available and ready to be used, even in urgent cases, as they typically do not require maintenance or sterilization. Compared with their reusable counterparts, single-use flexible ureteroscopes have similar digital performance (270°), image quality and we found no difference in the success and complication rates.
      Cost analysis of a reusable flexible ureteroscope must consider the purchase price, maintenance and repair costs, and decontamination costs (including handling, detergent, bacterial culture, transportation, and storage costs). In contrast, only purchase price is included in cost analysis for single-use flexible ureteroscopes. Our study suggests that single-use flexible ureteroscopes may be associated with lower costs per procedure than their reusable counterparts.

      Conclusion

      Single-use flexible ureteroscopes are an interesting alternative to their reusable counterparts, particularly in terms of material resource management. Cost analyses conducted using a low volume of cases representative of a paediatric urology division favour the use of single-use ureteroscopes.

      Keywords

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      References

        • Ishii H.
        • Griffin S.
        • Somani B.K.
        Flexible ureteroscopy and lasertripsy (FURSL) for paediatric renal calculi: results from a systematic review.
        J Pediatr Urol. 2014; 10: 1020-1025https://doi.org/10.1016/J.JPUROL.2014.08.003
        • Li J.
        • Yu H.
        • Zhou P.
        • Pan H.
        • Li R.
        • Wang Y.
        • Song C.
        • Lou Y.
        • Zhu J.
        Application of flexible ureteroscopy combined with holmium laser lithotripsy and their therapeutic efficacy in the treatment of upper urinary stones in children and infants.
        Urol J. 2019; 16: 343-346https://doi.org/10.22037/UJ.V0I0.4640
      1. EAU Guidelines. Edn. presented at the EAU Annual Congress Milan 2021. ISBN 978-94- 92671- 13-4.

        • Azili M.
        • Ozcan F.
        • Tiryaki T.
        Retrograde intrarenal surgery for the treatment of renal stones in children: factors influencing stone clearance and complications.
        Pediatr Surg. 2014; 49: 1161-1165https://doi.org/10.1016/j.jpedsurg.2013.12.023
        • Carey R.I.
        • Gomez C.S.
        • Maurici G.
        • Lynne C.M.
        • Leveillee R.J.
        • Bird V.G.
        Frequency of ureteroscope damage seen at a tertiary care center.
        J Urol. 2006; 176: 607-610https://doi.org/10.1016/J.JURO.2006.03.059
        • Semins M.J.
        • George S.
        • Allaf M.E.
        • Matlaga B.R.
        Ureteroscope cleaning and sterilization by the urology operating room team: the effect on repair costs.
        J Endourol. 2009; 23: 903-905https://doi.org/10.1089/END.2008.0489
        • Sabnis R.B.
        • Bhattu A.
        • Vijaykumar M.
        Sterilization of endoscopic instruments.
        Curr Opin Urol. 2014; 24: 195-202https://doi.org/10.1097/MOU.000000000000003413
        • Rajamahanty S.
        • Grasso M.
        Flexible ureteroscopy update: indications, instrumentation and technical advances.
        Indian J Urol. 2008; 24: 532-537https://doi.org/10.4103/0970-1591.44263
        • Emiliani E.
        • Mercadé A.
        • Millan F.
        • Sánchez-Martín F.
        • Konstantinidis C.A.
        • Angerri O.
        First clinical evaluation of the new single-use flexible and semirigid Pusen ureteroscopes.
        Cent Eur J Urol. 2018; 71: 208-213https://doi.org/10.5173/CEJU.2018.1620
        • Ventimiglia E.
        • Somani B.K.
        • Traxer O.
        Flexible ureteroscopy: reuse? Or is single use the new direction?.
        Curr Opin Urol. 2020; 30: 113-119https://doi.org/10.1097/MOU.0000000000000700
        • Davis N.F.
        • McGrath S.
        • Quinlan M.
        • Jack G.
        • Lawrentschuk N.
        • Bolton D.M.
        Carbon Footprint in Flexible Ureteroscopy: A Comparative Study on the Environmental Impact of Reusable and Single- Use Ureteroscopes.
        J Endourol. 2018; 32: 214-217https://doi.org/10.1089/end.2018.0001
        • Doizi S.
        • Kamphuis G.
        • Giusti G.
        • Andreassen K.H.
        • Knoll T.
        • Osther P.J.
        • Scoffone C.
        • Pérez-Fentes D.
        • Proietti S.
        • Wiseman O.
        • de la Rosette J.
        • Traxer O.
        First clinical evaluation of a new single-use flexible ureteroscope (LithoVueTM): a European prospective multicentric feasibility study World.
        J Urol. 2017; 35: 809-818https://doi.org/10.1007/s00345-016-1936-x
        • Tom W.R.
        • Wollin D.A.
        • Jiang R.
        • Radvak D.
        • Simmons W.N.
        • Preminger G.M.
        • Lipkin M.E.
        Next-Generation Single-Use Ureteroscopes: An In Vitro Comparison.
        J Endourol. 2017; 31: 1301-1306https://doi.org/10.1089/end.2017.0447
        • Winship B.
        • Wollin D.
        • Carlos E.
        • Li J.
        • Preminger G.M.
        • Lipkin M.E.
        Avoiding a Lemon: Performance Consistency of Single-Use Ureteroscopes.
        J Endourol. 2019; 33 (13): 127https://doi.org/10.1089/end.2018.0805
        • Usawachintachit M.
        • Isaacson D.S.
        • Taguchi K.
        • Tzou D.T.
        • Hsi R.S.
        • Sherer B.A.
        • Stoller M.L.
        • Chi T.J.
        A Prospective Case-Control Study Comparing LithoVue, a Single-Use, Flexible Disposable Ureteroscope, with Flexible, Reusable Fiber-Optic Ureteroscopes.
        Endourol. 2017; 31: 468-475https://doi.org/10.1089/end.2017.0027
        • Mager R.
        • Kurosch M.
        • Höfner T.
        • Frees S.
        • Haferkamp A.
        • Neisius A.
        Clinical outcomes and costs of reusable and single-use flexible ureterorenoscopes: a prospective cohort study Urolithiasis. 2018; 46: 587-593https://doi.org/10.1007/s00240-018-1042-1
        • Taguchi K.
        • Usawachintachit M.
        • Tzou D.T.
        • Sherer B.A.
        • Metzler I.
        • Isaacson D.
        • Stoller M.L.
        • Chi T.
        Micro-Costing Analysis Demonstrates Comparable Costs for LithoVue Compared to Reusable Flexible Fiberoptic Ureteroscopes.
        J Endourol. 2018; 32: 267-273https://doi.org/10.1089/end.2017.0523
        • Afane J.S.
        • Olweny E.O.
        • Bercowsky E.
        • Sundaram C.P.
        • Dunn M.D.
        • Shalhav A.L.
        • McDougall E.M.
        • Clayman R.V.
        Flexible ureteroscopes: a single center evaluation of the durability and function of the new endoscopes smaller than 9Fr.
        J Urol. 2000; 164: 1164-1168
        • Carey R.I.
        • Gomez C.S.
        • Maurici G.
        • Lynne C.M.
        • Leveillee R.J.
        • Bird V.G.
        Frequency of ureteroscope damage seen at a tertiary care center.
        J Urol. 2006; 176 (discussion 610): 607-610https://doi.org/10.1016/j.juro.2006.03.059
        • Al-Balushi K.
        • Martin N.
        • Loubon H.
        • Baboudjian M.
        • Michel F.
        • Sichez P.C.
        • Martin T.
        • Di-Crocco E.
        • Gaillet S.
        • Delaporte V.
        • Akiki A.
        • Faure A.
        • Karsenty G.
        • Lechevallier E.
        • Boissier R.
        Comparative medicoeconomic study of reusable vs. single-use flexible ureteroscope.
        Int Urol Nephrol. 2019; 51: 1735-1741https://doi.org/10.1007/s11255-019-02230-1
        • Hennessey D.B.
        • Fojecki G.L.
        • Papa N.P.
        • Lawrentschuk N.
        • Bolton D.
        Single-use disposable digital flexible ureteroscopes: an ex vivo assessment and cost analysis.
        BJU Int. 2018; 1: 55-61https://doi.org/10.1111/bju.14235
        • Martin C.J.
        • McAdams S.B.
        • Abdul-Muhsin H.
        • Lim V.M.
        • Nunez-Nateras R.
        • Tyson M.D.
        • Humphreys M.R.
        The Economic Implications of a Reusable Flexible Digital Ureteroscope: A Cost-Benefit Analysis.
        J Urol. 2017; 197: 730-735https://doi.org/10.1016/j.juro.2016.09.085
        • Isaacson D.
        • Ahmad T.
        • Metzler I.
        • Tzou D.T.
        • Taguchi K.
        • Usawachintachit M.
        Defining the Costs of Reusable Flexible Ureteroscope Reprocessing Using Time-Driven Activity- Based Costing.
        J Endourol. 2017; 31: 1026-1031https://doi.org/10.1089/end.2017.0463
        • Ventimiglia E.
        • Godinez A.J.
        • Traxer O.
        • Somani B.K.
        Cost comparison of single-use versus reusable flexible ureteroscope: a systematic review.
        Turk J Urol. 2020; 46: S40-S45https://doi.org/10.5152/tud.2020.20223