Single-Use vs. Reusable Digital Flexible Ureteroscope to Treat Upper Urinary Calculi: A Propensity-Score Matching Analysis

Abstract

Objective: The purpose of this research was to compare the treatment outcomes and costs of a single-use and reusable digital flexible ureteroscope for upper urinary calculi.Methods: Four hundred forty patients with reusable digital flexible ureteroscope and 151 patients with single-use flexible digital ureteroscope were included in this study. Through exclusion and inclusion criteria and 1:1 propensity-score matching analysis based on baseline characteristics, ultimately, 238 patients (119:119) were compared in terms of treatment outcomes. The cost analysis was based on the costs of purchase, repair, and reprocessing divided by the number of all procedures in each group (450 procedures with reusable digital flexible ureteroscope and 160 procedures with single-use digital flexible ureteroscope).Results: There was no statistical significance in mean operation time (P = 0.666). The single-use digital flexible ureteroscope group has a shorter mean length of hospital stay than the reusable digital flexible ureteroscope group (P = 0.026). And the two groups have a similar incidence of postoperative complications (P = 0.678). No significant difference was observed in the final stone-free rate (P = 0.599) and the probability of secondary lithotripsy (P = 0.811) between the two groups. After 275 procedures, the total costs of a single-use flexible ureteroscope would exceed the reusable flexible ureteroscope.Conclusion: Our data demonstrated that the single-use digital flexible ureteroscope is an alternative to reusable digital flexible ureteroscopy in terms of surgical efficacy and safety for upper urinary calculi. In terms of the economics of the two types of equipment, institutions should consider their financial situation, the number of FURS procedures, the volume of the patient's calculus, surgeon experience, and local dealerships' annual maintenance contract when making the choice.

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).…”

“…Nine studies were included for operation time [ 17 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]: three studies were RCT [ 17 , 23 , 26 ], and six studies were non-RCT [ 19 , 20 , 21 , 22 , 24 , 25 ]. Between the whole reusable fURS and disposable fURS groups, there was no difference in operation time ( p = 0.12; MD = −5.31; 95% CI, −12.08 to 1.46; Figure 4 A).…”