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

Talyshinskii, Ali; Gauhar, Vineet; Castellani, Daniele; Knoll, Thomas; Shah, Kaushikkumar; Wan, Shaw P.; Somani, Bhaskar K.

doi:10.1097/mou.0000000000001152

Cited by 2 publications

(1 citation statement)

References 30 publications

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“…It has been suggested that su-fURS may be used to preserve ru-fURS in complex urological cases with a high risk of endoscopic injury or fracture. The use of su-fURS may be influenced by the volume of the procedure, the limited availability of sterilization equipment, the durability of ru-fURS, and the potential risk of infectious complications 66 . Adoption of a standardized technology known as ureteroscopic HLL is widespread in the field of urology in China.…”

Section: New Equipment New Technologymentioning

confidence: 99%

Recent advances in the treatment of renal stones using flexible ureteroscopys

He,

Dong,

Cai

et al. 2024

International Journal of Surgery

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Upper urinary tract stones are a common urological disease that can be treated by flexible ureteroscopy (FURS) through the natural urinary tract, in addition to extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL). The advantages of FURS are less trauma, faster recovery, and fewer complications, while its disadvantages include poor results of lithotripsy and stone extraction when dealing with larger stones, and prolonged operation time. Over the last two decades, the emergence of new technologies such as FURS combined with negative pressure suction, robot-assisted FURS, and artificially intelligent FURS, coupled with improvements in laser technology (the use of thulium fiber lasers (TFL) and the invention of single-use flexible ureteroscopes (su-fURS) suitable for primary level application, have significantly increased the global adoption of FURS. This surge in usage holds a promising future in clinical application, benefiting a growing number of patients with renal calculi. Accompanied by changes in technical concepts and therapeutic modalities, the scope of indications for FURS is broadening, positioning it as a potential primary choice for urolithiasis treatment in the future. This review outlines the progress in employing flexible ureteroscopy for the treatment of renal calculi in order to generate insights for further research.

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Section: New Equipment New Technologymentioning

confidence: 99%

Recent advances in the treatment of renal stones using flexible ureteroscopys

He,

Dong,

Cai

et al. 2024

International Journal of Surgery

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Multicentre study comparing outcomes of RIRS using traditional suction ureteral access sheath (SUAS) and flexible and navigable suction UAS (FANS)

Ong,

Somani,

Chew

et al. 2024

Journal of Clinical Urology

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Objective: We aim to compare the stone-free rate (SFR), complications, and re-treatment rates in retrograde intrarenal surgery (RIRS) using a traditional suction ureteral access sheath (SUAS) with the more advanced flexible and navigable suction UAS (FANS). Materials and methods: Retrospective analysis was performed on patients who underwent RIRS using SUAS versus FANS across five institutions internationally as part of an audit. We analysed baseline and pre-operative characteristics such as stone location and density, intra-operative characteristics such as type of ureteroscope and laser, laser, and fluoroscopy time, as well as post-operative complications and residual fragments (RFs). Results: A total of 45 patients were included in each arm, with no significant difference in baseline characteristics. The commonest sheath size in the FANS group was 10–12 Fr (64.4%), while 11–13 Fr was preferred in SUAS (73.3%). Despite similar lasers (thulium fibre laser (TFL) and high-power holmium laser with MOSES), stone dusting (48.9%) and popcorning (95.6%) were carried out in FANS with minimal need for baskets (4.4%), while popcorning (64.4%) and basket extraction (40.0%) were required in SUAS. Although FANS had significantly longer operative times (65 minutes versus 55 minutes), it also had significantly higher rates of 100% SFR (80.0% versus 13.3%), and lower rates of clinically significant residual fragment (CSRF) (8.9% versus 53.3%), clinically insignificant residual fragment (CIRF) (11.1% versus 33.3%), and reintervention for CSRF (4.4% versus 37.8%). In addition, minor complications such as intra-operative oozing from mucosa not requiring intervention (8.9% versus 31.1%) and post-operative fever (11.1% versus 40.0%) were less common in FANS. On additional multivariate analysis, FANS was the only significant factor for higher SFR. Discussion and conclusion: The results of our study demonstrate that with its flexible and navigable tip, FANS proves advantageous over SUAS in terms of improving immediate SFR with negligible complications. By navigating the sheath into targeted individual calyces, fragments and dust are more successfully aspirated. FANS can therefore help to achieve the trifecta of high single-stage SFR, minimal minor and no major complications, and negligible reintervention rates. Level of evidence: Not applicable.

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

Cited by 2 publications

References 30 publications

Recent advances in the treatment of renal stones using flexible ureteroscopys

Recent advances in the treatment of renal stones using flexible ureteroscopys

Multicentre study comparing outcomes of RIRS using traditional suction ureteral access sheath (SUAS) and flexible and navigable suction UAS (FANS)

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