Microdamage analysis of single-use flexible ureteroscope immediately after lithotripsy use

Abstract

This prospective ex vivo study investigated microdamage to single-use flexible ureteroscopes (fURS) after ureteroscopy and endoscopic combined intrarenal surgery (ECIRS). The performance of 30 WiScope devices (OTU Medical, San Jose, CA, USA) was examined immediately after use, dividing them into three equal groups: ureteroscopy and ECIRS in the prone and supine positions. The overall scope of microdamage assessment included the scope deflection, bending radius, resolution, and water flow rate. Additionally, we analyzed the association between scope status and surgical parameters. The deflection, bending radius, and resolution remained similarly above the thresholds in all groups. However, the water flow rate was below the threshold in seven scopes (70%) in the ureteroscopy group and none in the ECIRS groups (P = 0.001). Univariate and multivariable logistic regression analyses demonstrated that basket wire catheter use was associated with an increased risk for overall scope microdamage (odds ratio [OR], 22.70; P = 0.006 and OR, 22.40; P = 0.019, respectively). Stone size, total laser energy, and surgical position were not associated with a risk for scope microdamage. In conclusion, ureteroscopy was more closely associated with scope damage than ECIRS, and basket wire catheter use seemed to inflict more damage to the fURS.

Device Failure and Adverse Events Related to Single-use and Reusable Flexible Ureteroscopes: Findings and New Insights From an 11-Year Analysis of the Manufacturer and User Facility Device Experience Database

“…14,15 Thermal laser damage is known to occur most often in the distal 4 mm of the ureteroscope. 16,17 A recurrent theme from the reports was use of excess force by the surgeon, which resulted in instrument malfunction (eg over deflection) and/or serious injury (eg forceful removal of scope despite resistance, resulting in ureteral avulsion). Our results also serve as a reminder that while the surgeon does carry responsibility regarding their surgical technique, delivery of a safe URS service is truly a team effort.…”

Single use flexible ureteroscopes: Current status and future directions

“…Endoscopic combined intra‐renal surgery (ECIRS) is also argued as a scenario to consider SU models. However, a recent study found that use of accessories such as baskets rendered more damage to ureteroscopes than performing ECIRS 62 . It may be that with laser advancements such as pulse modulation and improved dusting capabilities, requirement for basket use goes down and scopes maintained longer.…”