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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Article info
Publication history
Accepted:
January 12,
2023
Received in revised form:
January 9,
2023
Received:
May 20,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
