Single-use flexible ureteroscopes: update and perspective in developing countries. A narrative review

Abstract

Flexible ureteroscopy is a well-established method for treatment of urinary stones but fl exible ureteroscopes are expensive and fragile devices with a very limited lifetime. Since 2006 with the advent of digital fl exible ureteroscopes a great evolution has occurred. The fi rst single-use fl exible 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-benefi ts of adopting single-use fl exible ureteroscopes in developing countries. Materials and Methods: an extensive review of articles listed at PubMed and published between 2000 and 2021 was performed. Results: Single-use fl exible ureteroscopes have a shaft with 65 to 68cm length and weight between 119 and 277g. Their defl ection goes up to 300 degrees. Their stone-free rates vary between 60 and 95% which is comparable to reusable scopes and operative times ranges from 54 to 86 minutes which are lower when compared to reusable fl exible scopes. Their costs vary between 800 and 3180 US dollars. Conclusion: single-use fl exible ureteroscopes are lighter and have superior quality of image when compared to fi beroptic ones. There are no defi nite data showing a higher stone-free rate or less complications with the use of single-use fl exible ureteroscopes. Each institution must perform a cost-benefi t analysis before making the decision of adopting or not such devices depending on the local circumstances.

Editorial Comment: Single-use flexible ureteroscopes: update and perspective in developing countries. A narrative review

“…In their article, Mazzucchi et al perfectly show different situations where we observe advantages and disadvantages of using each type of device and the different results found by different authors (1).…”

Will the advances in retrograde intrarenal surgery extinguish percutaneous nephrolithotomy for stones larger than 2 cm?

“…The key gamechangers related to RIRS evolution include the development of disposable ureteroscopes and the new Thulium fiber laser (TFL). Single-use devices offer some advantages over the reusable flexible ureteroscopes: they are lighter (which may prevent fatigue in long lasting cases especially when treating large burden stones), offer a better deflection angle and provide superior image quality ( 7 ). Other authors also observed single-use device was associated with shorter operative time and higher stone free rates with possibly less complications ( 8 – 10 ).…”

“…Other authors also observed single-use device was associated with shorter operative time and higher stone free rates with possibly less complications ( 8 – 10 ). Moreover, the use of disposable material may reduce total costs to the health care system, which is vital within developing countries perspectives, including Brazil ( 7 ). Current literature on TFL provides compelling results when compared to Holmium laser, indicating it is a milestone in RIRS: higher stone ablation rate (2 to 4 times faster), less calculi retropulsion and more efficient fragmentation generating smaller fragments.…”

Transurethral flexible ureteroscopic incision and drainage with holmium laser in the treatment of parapelvic renal cysts: A retrospective study

“…With the development of minimally invasive technology, Basiri et al (15)(16)(17)(18) reported that ureteroscopic incision and internal drainage were used to treat parapelvic cysts. In 1991, Kavoussi et al (19) reported that they successfully performed ureteroscopic incision and internal drainage by ureteroscopy.…”