Vantagens custo-efetivas da utilização de ureteroscópios flexíveis descartáveis em comparação com o uso de ureteroscópios flexíveis reprocessáveis

Objective: To analyze the cost-effectiveness of using disposable flexible ureteroscopes versus using reprocessable flexible ureteroscopes. Methods: Integrative literature review conducted in the SciELO, LILACS and MEDLINE databases, using the descriptors ureteroscopy, flexion resistance, marketing, cost-benefit analysis, and sterilization, whose object deals with the cost-effective advantages of using the flexible ureteroscope disposable. Results: Thirty-five articles were found and four were used in the study. In addition, characteristics of seven models of flexible ureteroscopes commercialized in Brazil, that are currently better known, were presented. The results were based on a joint analysis of the selected articles and characteristics of the flexible models presented, and discussed in two categories: the evolution of flexible ureteroscopes; and marketing mix - flexible single-use ureteroscopes. Conclusion: Despite the scarcity of research that deepens the costs of using a flexible single-use ureteroscope when compared to a reprocessable one, the benefits arising from the innovations added to these devices are notorious, giving a positive return both to the professional who uses it and to the patient, making it necessary to further analyze the possibility of migration from the “culture” of using flexible reprocessable ureteroscopes to disposable ones

Factors affecting the durability of flexible ureteroscopes: An academic center review

Objective: To analyze the factors which affect the durability of the flexible ureteroscope and the causes of scope damage in a single academic center. Material and Method: Between March 2014 and August 2017, 479 flexible ureteroscopic procedures, using 6 flexible ureteroscopes (Olympus model URF-V), were systematically reviewed. Data including indication for procedures, auxiliary device usage, the characteristics of scope damage, and the number of times a scope was used before requiring major repair were gathered. Fisher exact test and Chi-square test were used to evaluate the factors which caused the damage. Results: The major flexible ureteroscopic procedure performed was treatment of renal calculi (81%). The most common auxiliary device used was the Holmium laser (70%). The most common cause of damage requiring repair was working channel leakage (93%). The factor that affected the durability of flexible ureteroscopes was the size of laser fiber. Utilizing laser fiber 200 nm decreased scope damage significantly compared to various other sizes (p-value=0.002 and p-value<0.001). However, the usage of nitinol basket and ureteral access sheath did not affect the durability of flexible ureteroscopes. Conclusion: Large laser fibers are a risk factor for flexible ureteroscope damage. Utilizing small laser fibers during flexible ureteroscopy can decrease scope damage significantly.