Clinical Evaluation of Single-Use, Fiber-Optic, and Digital Ureterorenoscopes in the Treatment of Kidney Stones

Abstract

<b><i>Introduction:</i></b> Indication of ureteroscopy for the treatment of urolithiasis has expanded immensely over the last decade. Fiber-optic and digital reusable instruments present the standard in clinical practice, but various newly available single-use devices might offer an exciting alternative. To date, the evidence is limited to clinical evaluation and efficacy of single-use ureteroscopes (URS) compared to standard instruments. Therefore, we evaluate a single-use instrument’s clinical characteristics and efficacy in direct comparison with a fiber-optic and digital device. <b><i>Methods:</i></b> A prospective study was conducted for patients undergoing endoscopic therapy for urolithiasis at a tertiary care center. We evaluated the different instruments’ clinical performance in categories of visibility, the stability of visibility, irrigation flow, and surgeon’s satisfaction. Statistical analyses were performed by SPSS using the Chi-Quadrat and Kruskal-Wallis test. A <i>p</i> value of <i>p</i> ≤ 0.05 was defined as statistically significant. <b><i>Results:</i></b> A total number of 77 patients were included and distributed as follows: 35 (46.7%) single-use, 19 (25.3%) digital, and 23 (28%) fiber-optic URS. Patients’ characteristics were homogenous over the three cohorts in sex, stone amount, and localization. The stone-free rate was equal in all three cohorts (<i>p</i> = 0.31). We identify stability of visibility, irrigation flow, and satisfaction were equal in all cohorts (<i>p</i> = 0.73; <i>p</i> = 0.20; <i>p</i> = 0.20). We report a significant difference in visibility, with 100% rated excellent in the digital URS group (<i>p</i> = 0.028). <b><i>Discussion/Conclusions:</i></b> Single-use URS achieve comparable clinical outcomes with equal stone-free rates in direct comparison with fiber-optic and digital reusable instruments. Accordingly, single-use devices present an adequate alternative for endoscopic therapy of urolithiasis.

Comparison of Surgical Outcomes between Single-Use and Reusable Flexible Ureteroscopes for Renal Stone Management: A Systematic Review and Meta-Analysis

“…After the review of all the original articles, 11 studies related to this meta-analysis were identified ( Figure 1 ) [ 12 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. The characteristics of the 11 included studies are shown in Table 1 [ 12 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ].…”

“…After the review of all the original articles, 11 studies related to this meta-analysis were identified ( Figure 1 ) [ 12 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. The characteristics of the 11 included studies are shown in Table 1 [ 12 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. All these comparative studies included patients who underwent fURS for upper ureter and renal stones with reusable or disposable flexible ureterorenoscope.…”

“…The publication date of the included studies was from August 2015 to March 2022. Four of the eleven studies were performed in China [ 17 , 20 , 23 , 26 ]; two, in Germany [ 18 , 21 ]; one, in Australia [ 12 ]; one, in Chile [ 24 ]; one, in Greece [ 22 ]; one, in Turkey [ 19 ]; and one in the US [ 25 ].…”

“…Ten studies were included for the SFR [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]: three studies were RCT [ 17 , 23 , 26 ], and seven studies were non-RCT [ 18 , 19 , 20 , 21 , 22 , 24 , 25 ]. There was no difference in the SFR between whole reusable fURS and disposable fURS ( p = 0.14; OR = 1.36; 95% CI, 0.9 to 2.04; Figure 2 A).…”

“…( B ) SFR of disposable and digital reusable fURS. ( C ) SFR of disposable and fiber-optic reusable fURS [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ].…”