<i>In Vitro</i> Evaluation of Single-Use Digital Flexible Ureteroscopes: A Practical Comparison for a Patient-Centered Approach

Marchini, Giovanni Scala; Batagello, Carlos; Monga, Manoj; Torricelli, Fábio César Miranda; Vicentini, Fábio Carvalho; Danilovic, Alexandre; Srougi, Miguel; Nahas, Willian; Mazzucchi, Eduardo

doi:10.1089/end.2017.0785

Cited by 51 publications

(52 citation statements)

References 16 publications

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“…Despite good clinical results in those early trials, there has been no continuity in this research of late, probably due to the ever-evolving design simplicity of newer models. In their latest publication, Marchini et al [12] compare the Pusen TM scope against the Lithovue TM and the Flex-X 2TM ureteroscope (Karl Storz, Germany). Both disposable scopes showed similar flow rates with a laser fiber or Fr 1.3 basket in the working channel.…”

Section: Discussionmentioning

confidence: 99%

“…Both disposable scopes showed similar flow rates with a laser fiber or Fr 1.3 basket in the working channel. Lithovue TM had the best image resolution, while the Pusen TM was the lightest scope and thus easy to handle [12]. In their in vitro study, Tom et al [6] have shown that 2 of the newest instruments (YC-FR-A and the NeoFlex) have lost a significant part of their deflection with instruments placed in the working channel.…”

Section: Discussionmentioning

confidence: 99%

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Ex vivo Comparison of 2 Disposable versus a State-of-the-Art Reusable Ureterorenoscope

Bourdoumis

Howairis²,

Stephen

et al. 2019

Urol Int

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Introduction: The success of upper urinary tract endoscopy on one hand and the high cost of purchase and maintenance of the scopes on the other hand have driven the development of disposable digital flexible ureterorenoscopy (fURS). Materials and Methods:We performed an ex vivo comparison of 2 disposable digital fURS from different companies with a state-of-the-art reusable endoscope from another well-established scope manufacturer. The scopes were tested comparing parameters such as instrument handling, irrigation flow, image quality, and deflection. For the disposable scopes, the latter 2 were evaluated both, before and after vigorous stress testing. Results: Expectedly, the most consistent finding among the 3 instruments was the marked decrease on irrigation flow following insertion of a working element, most notably a guidewire. Depth perception and ergonomic handling were comparable in all 3 instruments.Poststress testing revealed a significant loss of upward deflection in both disposable instruments, more so when an auxiliary instrument is inserted into the working channel. However, this did not appear to be the case in downward deflection. Conclusions: To our knowledge, this is the first study that used a vigorous stress testing protocol comparing disposable and reusable fURS. The newer generation disposable scope fared better than the older one. Results are encouraging and indicate that improvements are ongoing and progressing, bringing the quality of disposable scopes to the level that we are used to from our reusable high performance scopes while at the same time avoiding costly damage repairs. Continuous research and evidence-based interpretation of results in the absence of commercial bias are paramount to ensure this ongoing development.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ex vivo Comparison of 2 Disposable versus a State-of-the-Art Reusable Ureterorenoscope

Bourdoumis

Howairis²,

Stephen

et al. 2019

Urol Int

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“…Some authors report that, in average, a digital ureteroscope is used 21 times before requiring repair, while the average fiberoptic ureteroscope is only used 6 to 15 times before going back to the manufacturer 26,27 . In a recent study by Legemate et al 23 , permanent digital scopes had a slightly longer longevity (mean 27 cases; 20-56) compared to fiber optic flexible ureteroscopes (mean 24 cases; 10-37). However, a wider look at all published literature reveal that new flexible scopes may last as long as 5 to 159 cases .…”

Section: Longevity Of Digital Optical New and Refurbished Flexible mentioning

confidence: 91%

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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“…There are many single‐use digital fURS already on the market, including LithoVue (Boston Scientific, Marlborough, MA, USA), PU3022A (Pusen, Zhuhai, China), Polyscope (Lumenis, Yokneam, Israel, Polydiagnost, Hallbergmoos, Germany), Semi‐Flex Scope (Maxiflex, Los Angeles, CA, USA), FlexoVue (Cook Medical, Bloomington, IN, USA) and Yc‐FR‐A (YouCare Tech, Wuhan, China) . In vitro testing has shown that single‐use scopes have equivalent optics, deflection ability and working channel flow rates to more expensive reusable scopes …”

Section: Introductionmentioning

confidence: 99%

“…11 In vitro testing has shown that single-use scopes have equivalent optics, deflection ability and working channel flow rates to more expensive reusable scopes. [12][13][14][15][16][17] In vivo testing has been limited. A European multicenter evaluation of the single-use LithoVue in 40 procedures found that operators rated the image quality as "good" or "very good" in 95% of cases.…”

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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In Vitro Evaluation of Single-Use Digital Flexible Ureteroscopes: A Practical Comparison for a Patient-Centered Approach

Cited by 51 publications

References 16 publications

Ex vivo Comparison of 2 Disposable versus a State-of-the-Art Reusable Ureterorenoscope

Ex vivo Comparison of 2 Disposable versus a State-of-the-Art Reusable Ureterorenoscope

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

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

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