RIRS with disposable or reusable scopes: does it make a difference? Results from the multicenter FLEXOR study

Abstract

Introduction: With several single-use ureteroscopes now available, our aim was to analyze and compare data obtained globally from high-volume centers using both disposable and reusable flexible ureteroscopes and see if indeed in real-world practice either scope has a distinct advantage. Methods: Retrospective analysis was performed on the FLEXOR registry, which was created as a TOWER group (Team of Worldwide Endourological Researchers, research wing of the Endourological Society) endeavor. Patients who underwent retrograde intrarenal surgery (RIRS) for renal stones from January 2018 to August 2021 were enrolled from 20 centers globally. A total of 6663 patients whose data were available for analysis were divided into Group 1 (Reusable scopes, 4808 patients) versus Group 2 (Disposable scopes, 1855 patients). Results: The age and gender distribution were similar in both groups. The mean stone size was 11.8 mm and 9.6 mm in Groups 2 and 1, respectively ( p < 0.001). Group 2 had more patients with >2 cm stones, lower pole stones and of higher Hounsfield unit. Thulium fiber laser (TFL) was used more in Group 2 ( p < 0.001). Patients in Group 2 had a slightly higher stone-free rate (SFR) (78.22%) and a lower number of residual fragments (RFs) compared with Group 1 ( p < 0.001). The need for further treatments for RF and overall complications was comparable between groups. On multivariate analysis, overall complications were more likely to occur in elderly patients, larger stone size, lower pole stones, and were also more when using disposable scopes with longer operative time. RFs were significantly higher ( p < 0.001) for lower pole, larger, harder, multiple stones and in elderly. Conclusion: Our real-world practice observations suggest that urologists choose disposable scopes for bigger, lower pole, and harder stones, and it does indeed help in improving the single-stage SFR if used correctly, with the appropriate lasers and lasing techniques in expert hands.

Single use flexible ureteroscopes: a review of current technologies and cost effectiveness analysis

“…Ozimek et al [20] determined the average cost of ru-fURS to be €503.26 per case and concluded that su-fURS would be more expensive in high volume centers, but that they may be cost effective in certain cases involving high risk of scope damage, such as multiple or large stones in the lower pole of recurrent stone formers and a steep infundibular pelvic angle. Gauhar et al [21] conducted a retrospective analysis of the FLEXOR registry in order to examine data collected globally from high-volume centers employing both su- and ru-fURS. According to the results, urologists choose su-fURS for bigger, lower pole, and harder stones, and it does indeed aid in improving the single-stage SFR if used correctly.…”

Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group

“…Many studies focus on several variables like demographic factors, 1 stone parameters, 2 and intraoperative technical steps and technology used 3 to predict stone-free rate (SFR) and outcomes of retrograde intrarenal surgery (RIRS) in adults and children alike. Similarly, preoperative computerized tomography (CT) imaging for endourological intervention is ideal for kidney stones and to estimate stone parameters like Hounsfield units (HU), 4 and its ability to influence decision-making for RIRS has been well documented.…”