Durability of Flexible Ureteroscopes: A Prospective Evaluation of Longevity, the Factors that Affect it, and Damage Mechanisms

Legemate, Jaap D.; Kamphuis, Guido; Freund, Jan Erik; Baard, Joyce; Zanetti, S.P.; Catellani, Michele; Oussoren, Harry W.; Rosette, Jean J. de la

doi:10.1016/j.euf.2018.03.001

Cited by 44 publications

(42 citation statements)

References 17 publications

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Section: Discussionmentioning

confidence: 99%

“…In a recently published prospective study from Legemate et al 23 , the durability of the latest generation of digital and fiberoptic reusable flexible endoscopes were evaluated. The durability was limited to 27 uses (in summary about 14 working-hours), the damage of the shaft was the most important limitation 23 . These findings are in agreement with the results from other studies published in literature, in some studies the lifetime is even shorter depending on whether it is a fiberoptic or digital instrument 24,25 .…”

Section: Discussionmentioning

confidence: 99%

“…laser lithotripsy, could become more cost effective. The reason is that sterilization or repair procedures are not required for disposable devices, which are one of the main expense factors [12][13][14][15] . In the present study a disposable flexible endoscope (PU3022A, Zhuhai PUSEN Medical Technology, Zhuhai, Guangdong China) 16 was systematically tested with special interest in the image quality in terms of spatial resolution and distortion, as well as the maximal bending capability and the irrigation flow.…”

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confidence: 99%

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Comparative investigation of reusable and single–use flexible endoscopes for urological interventions

Eisel

Strittmatter

Ströbl

et al. 2020

Sci Rep

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In order to evaluate the technical adaptability of a type of disposable endoscope compared to reusable flexible endoscopes, in vitro and in vivo studies were conducted. A disposable digital ureteroscope ("chip on tip") and two reusable endoscopes were investigated with respect to spatial resolution, geometric distortion in air and water the maximum. Additionally, the clinical performance of the disposable device was tested during clinical procedures (n = 20). The disposable endoscope showed an optical resolution of 6.72 lines/mm at 10 mm distance, similar to the other devices. In comparison, the disposable endoscope showed a barrel-shaped image distortion in air of −24.2%, which is in the middle range, but was best under water (−8.6%). The bendability of 297° (275 µm fiber) and 316° (empty channel, 1.5 F basket) and the maximum irrigation (1 m: 58.1 ml/min, 2 m: 91.9 ml/min) were convincing. Clinically the maneuverability was very good in (13/20), good or satisfactory in (7/20). Visibility was evaluated as very good in (11/20), just in (1/20) either satisfactory or sufficient. The consistency of visibility was not affected in (19/20). In all cases there were no adverse events. The technical examination and clinical application of the disposable endoscope are of equal quality compared to reusable devices. Disposable endoscopes can be an alternative to reusable devices, but economic aspects such as reduction of repair costs, sterilization effort and additional waste must be taken into account.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Comparative investigation of reusable and single–use flexible endoscopes for urological interventions

Eisel

Strittmatter

Ströbl

et al. 2020

Sci Rep

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“…Of the remaining 646 studies, 59 published between 2000 and 2018 were considered of relevance to the pre-defined queries and were selected for further analysis. The studies consisted of four randomized controlled trial 9,11,38,56 , three multicenter trials 17,30,33 , 40 case series 5,8,10,12,13,15,16,[25][26][27][28][29]31,32,[34][35][36][37]39,41,42,[44][45][46][47][48][49][50][51][52]54,55,[57][58][59][60][61][62][63]66 , one cadaveric feasibility study 18 , one animal feasibility study 19 , and ten bench top studies…”

Section: Resultsmentioning

confidence: 99%

Single-use versus reusable flexible ureteroscopes: a comprehensive cost-analysis decision model

Marchini

Torricelli

Batagello

et al. 2018

Rev. Med. (São Paulo)

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Purpose: The significant improvements in flexible ureterorenoscopes have made flexible ureteroscopy the main treatment modality to target upper urinary pathologies. The purpose of this study was to critically evaluate all literature concerning the cost-effectiveness of flexible ureteroscopy comparing single-use with reusable scopes. Methods: A systematic online literature review was performed in PubMed, Embase and Google Scholar databases. Two separate urologists (GSM and FCT) performed the online search and reviewed all papers considered suitable and relevant for this analysis. Because of the paucity of high quality publications, not only prospective assessments but also case control and case series studies were included in the final analysis. All factors potentially affecting surgical costs or clinical outcomes were considered in the analysis. Results: 741 studies with the previously elected terms were found. Of those, 18 were duplicated and 77 were not related to urology procedures and were excluded. Of the remaining 646 studies, 59 published between 2000 and 2018 were considered of relevance to the pre-defined queries and were selected for further analysis. Stone free and complication rates were similar between single-use and reusable scopes. In special, urinary tract infection rate following flexible ureteroscopy is not inferior if a single-use device is used instead of a reusable scope. Operative time was in average 20% shorter if a digital scope was used, single-use or not. There is a suggestion that the learning curve is shorter with single-use devices but this is not consistent in the literature. Surgeon expertise impacts the longevity of the flexible scope. Reusable digital scopes seem to last longer than optic ones, though scope longevity is very variable worldwide. New scopes usually last three to four times more than refurbished ones and single-use ureterorenoscopes have good resilience throughout long cases. Both sterilization method and cleaning process impact scope longevity, the best results being achieved with Cidex and a dedicated nurse to take care of the sterilization process. The main factors that negatively impact device longevity regarding patient and disease are lower pole pathologies, large stone burden and non-use of a ureteral access sheath. Conclusions: The cost-effectiveness of a flexible ureteroscopy program is dependent of several aspects that must be considered when deciding whether to choose between a single-use and a reusable ureterorenoscope. Disposable devices are already a reality and will progressively become the standard as manufacturing price falls significantly.

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“…Only limited and outdated evidence on optimal scheduling of these cleaning and sterilization processes is available in literature [39,40]. Recent studies detailing sterilization processes of flexible ureteroscopes did not evaluate the grade of sterility and possible residual contamination, but rather reported on a possible association between sterilization processes and instrument damages [41][42][43][44][45][46]. Of note, there was a wide heterogeneity in cleaning and sterilization protocols in these studies.…”

Section: Image 1-smentioning

confidence: 99%

Which flexible ureteroscope is the best for upper tract urothelial carcinoma treatment?

et al. 2019

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PURPOSE To present attributes of currently available flexible ureteroscopes to define the best flexible ureteroscope for upper tract urothelial carcinoma (UTUC) treatment. MATERIALS AND METHODS Scopus and Medline databases were searched for articles relating to performance of flexible ureteroscopes. A consensus for final inclusion of articles judged to be relevant for UTUC treatment was reached between the authors. Instrument characteristics were extracted from manufacturers' product brochures. RESULTS Smaller cross-sectional size of instruments is associated with increased probability for successful primary access to the upper urinary tract. The smallest flexible ureteroscopes are fiberoptic scopes. Smaller ureteroscopes also allow comparatively increased irrigation flow at constant intrarenal pressure. Digital flexible ureteroscopes achieve superior image quality compared to their fiberoptic counterparts, at the price of lower end-deflection ability. Image enhancement technologies such as narrowband imaging (NBI), photodynamic diagnosis (PDD) and Image 1-S (formerly SPIES) are based on subjective image interpretation by the operator. NBI and PDD significantly increase tumor detection rate. The highest subjective image quality score of the Image 1-S technology is reached by the "Clara + Chroma" mode. Single-use ureteroscopes offer potential advantages over reusable scopes, including sterility, absence of contamination, immediate availability and exemption of previous instrument wear. CONCLUSIONS Miniaturization, digital image caption and image enhancement technologies seem to be the major determinants defining the best flexible ureteroscope for UTUC treatment. The impact of further factors, such as distal tip design, torque, working channel position, risk of contamination, as well as upcoming technological innovations should be evaluated in randomized controlled trials.

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Durability of Flexible Ureteroscopes: A Prospective Evaluation of Longevity, the Factors that Affect it, and Damage Mechanisms

Cited by 44 publications

References 17 publications

Comparative investigation of reusable and single–use flexible endoscopes for urological interventions

Comparative investigation of reusable and single–use flexible endoscopes for urological interventions

Single-use versus reusable flexible ureteroscopes: a comprehensive cost-analysis decision model

Which flexible ureteroscope is the best for upper tract urothelial carcinoma treatment?

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