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

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.

Efficacy and safety of single-use flexible ureteroscope（ZebraScopeTM）for the treatment of upper urinary tract calculi ≤ 2 cm

Purpose To evaluate the clinical efficacy and safety of a Chinese single-use flexible ureteroscope (ZebraScopeTM) for the treatment of upper urinary tract calculi ≤2 cm based on a retrospective database. Methods Overall, 84 patients with upper urinary tract calculi who underwent FURS at our hospital from July, 2020 to January, 2021 were enrolled and reviewed. Demographic characteristics and perioperative data were evaluated and analyzed. Results We identified 84 patients: 51 male and 33 female. The mean age of the patients was(49.63±12.23)years, and the mean body mass index was༈24.44±3.62༉Kg/m2. The degree of hydronephrosis was absent, mild, moderate and severe in 24, 35, 21 and 4 patients, respectively. The average operation time was༈74.57±42.51༉min, and the average blood loss was༈5.28±4.99༉ml. The catheter retention time was༈1.71±0.99༉day and the double-J tube retention time was༈32.89±13.23༉day. The length of hospital stay was༈4.29±3.28༉day. The stone-free rate was 77.78% after 1-month, and the cost of hospitalization was ¥༈34619±8719.16༉. The overall complication rate was 4.76%. There were significant increase in leukocyte, neutrophils, and decrease in urea nitrogen, albumin and globulin after surgery (P༜0.05), while no significant difference were observed in hemoglobin and creatinine (P༞0.05). Conclusion The Chinese single-use ureteral flexible ureteroscope (ZebraScopeTM)can be considered effective and safe for the treatment of upper urinary tract calculi ≤ 2 cm.

Observations on the Curative Effect of a Holmium Laser Under a Flexible Ureteroscope in the Treatment of Endogenous Renal Cysts Combined with Renal Calculi

Background: To explore and analyse the curative effects of a holmium laser under a flexible ureteroscope in the treatment of endogenous renal cysts complicated with renal calculi. Methods: Seven patients with endogenous renal cysts and renal calculi were admitted to our hospital from April 2019 to April 2021. The renal calculi was smashed by a holmium laser under a flexible ureteroscope, and the kidney cysts were opened by holmium laser endotomy. Window decompression was performed, indwelling the ureteral double-J tube for 1 month after the operation. After 1 month, when the patient was hospitalized and the double-J tube was removed, a flexible ureteroscope was inserted into the renal pelvis to confirm the effect of window opening and lithotripsy, and CT or B-ultrasound was reviewed. Results: Among the 7 patients with endogenous renal cysts and kidney stones, one patient was scheduled to undergo an internal incision after successful lithotripsy. The renal cyst wall tissue was surrounded by the renal artery, and the internal incision was terminated. One patient had an unsuccessful lithotripsy due to the poor angle of the kidney stone but was successfully treated for the renal cyst. The remaining 5 patients successfully underwent lithotripsy and internal incision surgery, of which 2 cases had difficulty finding kidney cysts and stones during the operation and needed assistance in locating kidney cysts and kidney stones under B-ultrasound monitoring. The average operation time was 42 minutes. When the catheter was extubated, the diameter of the renal cyst window was 0.5 cm to 2.5 cm under a flexible ureteroscope. The stone discharge was fair. There were residual gravels in the lower calyx of the kidney in two patients, and the stone basket was removed. After extubation, the maximum diameter of the renal cyst was reduced by more than half by CT or B-ultrasound, the effect of fenestration and decompression was achieved, and there were no obvious residual stones. Conclusions: A holmium laser under a flexible ureteroscope has a reliable curative effect in the simultaneous treatment of endogenous renal cysts with kidney stones, with little damage, quick recovery, and low cost. It can be used as the first choice for the treatment of endogenous renal cysts with kidney stones.

Comparison Between Single-Use Flexible Ureteroscope and Reusable Flexible Ureteroscope for Upper Urinary Calculi: A Systematic Review and Meta-Analysis

Objective: This article explores the differences in the effectiveness and safety of the treatment of the upper urinary calculi between single-use flexible ureteroscope (su-fURS) and reusable flexible ureteroscope (ru-fURS).Methods: We systematically searched PubMed, Embase, Cochrane Library, Scopus database, and CNKI databases within a period from the date of database establishment to November 2020. Stata 16 was used for calculation and statistical analyses.Results: A total of 1,020 patients were included in the seven studies. The statistical differences were only found in the Clavien–Dindo grade II postoperative complication [odds ratio (OR) 0.47; 95% CI 0.23–0.98; p = 0.04]. No significant statistical differences were observed in operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), and stone-free rate (SFR).Conclusion: Our meta-analysis results demonstrate that su-fURS, compared with ru-fURS, has similar effectiveness and better security for treating upper urinary calculi.

Flexible ureteroscope with ultrasound guidance for treatment of parapelvic renal cysts: A complementary approach to locate the cystic wall

Background The main treatment of parapelvic cysts is flexible ureteroscope currently. Considering the intraoperative localization of the cyst may fail with flexible ureteroscope, we tend to use an innovative method by ultrasound-guided for easily locating cystic wall during flexible ureteroscopic surgery Methods We retrospectively reviewed 17 consecutive cases of parapelvic renal cysts treated by ultrasound-guided flexible ureteroscope between March 2017 and May 2020. The differences of simple flexible ureteroscopic technique and ultrasound-guided flexible ureteroscopic technique were compared. The surgical procedures, postoperative complications, results and patients’ follow-ups were evaluated. Results The cysts wall were seen clearly in 10 patients with ureteroscopic vision. Another 7 patients changed to ultrasound-guided flexible ureteroscopic surgery since it was difficult to identify the cyst wall. Mean operative time were 25.9 ± 8.7 minutes and 37.1 ± 10.1 minutes for conventional and modified technique respectively (P =0.004), of which 17.6 ± 5.8 minutes and 26.5 ± 8.4 minutes to search the cysts, respectively (P = 0.002), and the mean time of the incising were 7.1 ± 4.9 minutes and 12.1 ± 5.6 minutes, respectively (P = 0.000). All of the patients were followed-up 12 months, there were no serious complications and recurrence observed. Conclusions We demonstrated that it is feasible and safe to treat parapelvic renal cyst by ultrasound-guided flexible ureteroscopic incision and drainage. The less sample size and further studies were the limitations of our study.

Comparison of a single-use, digital flexible ureteroscope with a reusable, fiberoptic ureteroscope for management of patients with urolithiasis

Objectives: Ureteroscopy is one of the commonest procedures performed to manage urolithiasis. Flexible ureteroscopy has been traditionally based on reusable, fiber-optic ureteroscopes. Technology advancements permitted the development of single-use scopes with digital image. The aim of this study is to compare efficacy and safety between a reusable, fiberoptic ureteroscope with a single-use, digital scope. Patients and methods: We collected data based on chart review from a prospectively collected database on a tertiary, high-volume hospital in Greece. Baseline, perioperative and postoperative data were gathered and analyzed. Chi-square and Fisher's exact test was used to compare qualitative data and unpaired t-test for continuous data, with a statistical significance set at a = 0.05. Results: 40 patients underwent flexible ureteroscopy with a single- use digital scope, while 37 with the reusable scope. The two groups were matched regarding baseline characteristics and stone-related parameters. After data analysis, a shorter operative time in favor of single-use flexible ureteroscope was detected (45 vs 65 min, p = 0.001), while safety was also in favor of this type of scope with a significantly higher immediate stonefree rate (70% vs 43%, p = 0.005). Overall complications did not differ between the two groups, although a lower sepsis rate was detected in patients treated with single-use scope. Conclusions: Our findings indicate that single-use, digital ureteroscopes are a viable alternative for flexible ureteroscopy and management of urolithiasis, especially in centers with deficient facilities for sterilization and ensured funds for more expensive reusable scopes.