Retrospective Cost Analysis of a Single-Center Reusable Flexible Ureterorenoscopy Program: A Comparative Cost Simulation of Disposable fURS as an Alternative

Ozimek, Tomasz; Schneider, Michael; Hupe, Marie C.; Wießmeyer, Judith Riccarda; Cordes, Jens; Chłosta, Piotr; Merseburger, Axel S.; Kramer, Mario W.

doi:10.1089/end.2017.0427

Cited by 46 publications

(44 citation statements)

References 18 publications

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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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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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“…The detailed course of fURS procedures performed at our department has already been described in previous articles from our working group [7,8]. In summary, written patient consent was obtained at least 24 h preoperatively.…”

Section: Methodsmentioning

confidence: 99%

“…Due to its minimal invasiveness and acceptable level of difficulty, fURS has already been incorporated into many departments as a part of residents' training. On the other Urol Int 2020;104:452-458 DOI: 10.1159/000504989 hand, a persistent time pressure in the operation theatre, a substantial intra-and postoperative complication rate [5,6], as well as economic and logistic consequences of reusable flexible ureteroscope damage [7] challenge training aims, operative efficiency, and patient safety. The goal of our study was to retrospectively analyze the influence of residents' participation in fURS procedures on intraand postoperative outcomes.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Endourological Experience on Flexible Ureteroscopy Outcomes and Performance at Different Levels of Expertise: Retrospective Multifactorial Analysis

et al. 2020

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Introduction: The aim of this study was to analyze the influence of residents' participation in flexible ureteroscopy (fURS) on intra-and postoperative outcomes. Materials and Methods: Intra-and postoperative parameters were compared in a retrospective monocentric setting between 3 groups: "resident group" (47 cases) for surgeries performed by experienced residents alone, "consultant group" (245 cases) for surgeries performed by consultants alone, "resident plus consultant group" (124 cases) for training surgeries between September 2013 and June 2017. Results: Patients operated by residents alone had a significantly smaller median kidney stone diameter (5.0 vs. 7.0 mm for "consultant group" and 6.0 mm for "resident plus consultant group," p = 0.011), shorter operating time (median 47.0 vs. 63.0 and 77.0 min, p < 0.001) and fluoroscopy time (median 39.0 vs. 69.5 and 89.0 s, p < 0.001), as well as shorter postoperative hospital stay (p = 0.013). The laser application rate was the smallest in the "resident group" (10.64 vs. 31.43 and 29.84%, p = 0.009). Univariate analysis revealed no relevant differences regarding flexible ureteroscope defect rate, postoperative stone-free rate, or ≥2 Clavien-Dindo classification complications between the groups (p > 0.05). Conclusion: A proper case selection of less complicated cases, especially without laser application, could balance the experience deficit of the residents. fURS can be incorporated as a part of residents' training without an impact on fURS device defect rate or clinical outcomes.

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“…Concerns over the sterilizing process for reusable fURS and their link to the transmission of infection between patients, and an increasing consciousness about the environmental impact of fURS have also elevated the profile of single‐use fURS . Several studies have shown that single‐use fURS are becoming more economically viable, especially in lower‐volume centers and for cases with a higher risk of damage to reusable fURS . Several studies have shown that reusable fURS suffer damage requiring repair after 10–25 cases .…”

Section: Introductionmentioning

confidence: 99%

“…5 Several studies have shown that single-use fURS are becoming more economically viable, especially in lower-volume centers and for cases with a higher risk of damage to reusable fURS. [6][7][8] Several studies have shown that reusable fURS suffer damage requiring repair after 10-25 cases. 9,10 Once a ureteroscope has been repaired, it is more likely to be damaged again, requiring further repair.…”

Section: Introductionmentioning

confidence: 99%

Single use versus reusable digital flexible ureteroscopes: A prospective comparative study

et al. 2019

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Objectives To compare the performance and surgical outcomes of two different single‐use digital flexible ureteroscopes with a reusable video flexible ureteroscope. Methods Patients undergoing retrograde flexible ureteroscopy at Nepean Hospital, Sydney, Australia, were included in this study. Three different flexible ureteroscopes were used in this study: (i) single‐use digital LithoVue (Boston Scientific, Marlborough, MA, USA); (ii) single‐use digital PU3022A (Pusen, Zhuhai, China); and (iii) reusable digital URF‐V2 (Olympus, Tokyo, Japan). Visibility and maneuverability was rated on a 5‐point Likert scale by the operating surgeon. Operative outcomes and complications were collected and analyzed. Results A total of 150 patients were included in the present study. Of these, 141 patients had ureteroscopy for stone treatment, four for endoscopic combined intrarenal surgery and five for diagnostic/tumor treatment. There were 55 patients in the LithoVue group, 31 in the PU3022A group and 64 patients in the Olympus URF‐V2 group. The URF‐V2 group had higher visibility scores than both the single‐use scopes and higher maneuverability scores when compared with the PU3022A. The LithoVue had higher visibility and maneuverability scores when compared with the PU3022A. There were no differences in operative time, rates of relook flexible ureteroscopes, scope failure or complication rates observed. Conclusions Single‐use digital flexible ureteroscopes have visibility and maneuverability profiles approaching that of a reusable digital flexible ureteroscope. Single‐use flexible ureteroscopes achieve similar clinical outcomes to the more expensive reusable versions.

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Retrospective Cost Analysis of a Single-Center Reusable Flexible Ureterorenoscopy Program: A Comparative Cost Simulation of Disposable fURS as an Alternative

Cited by 46 publications

References 18 publications

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

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

The Impact of Endourological Experience on Flexible Ureteroscopy Outcomes and Performance at Different Levels of Expertise: Retrospective Multifactorial Analysis

Single use versus reusable digital flexible ureteroscopes: A prospective comparative study

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