Abstract
Flexible ureterolithotripsy is a frequent urological procedure, usually used to remove stones from the kidney and upper ureter. Reusable uretero-scopes were the standard tool for that procedure, but recent concerns related to sterility and maintenance and repair costs created the opportunity to develop new technologies. In 2016, the first single-use digital flexible ureteroscope was introduced. Since then, other single-use ureteroscopes were developed, and studies compared them with the reusable ureteroscopes with conflicting results. The purpose of this study is to describe the literature that compares the performance of single-use and reusable flexible ureteroscopes in retrograde intrarenal surgery for urinary stones. A Systematic Review was performed in October 2022 in accordance with the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA). A search in MEDLINE, EMBASE, Web of Science, Google Scholar and LILACS retrieved 10,039 articles. After screening, 12 articles were selected for the Meta-Analysis. No differences were found in stone-free rate (OR 1.31, CI 95% [0.88, 1.97]), operative time (MD 0.12, CI 95% [−5.52, 5.76]), incidence of post-operative fever (OR 0.64, CI 95% [0.22, 1.89]), or incidence of post-operative urinary tract infection (OR 0.63 CI 95% [0.30, 1.32]). No differences were observed in the studied variables. Hence, the device choice should rely on the availability, cost analysis and surgeons’ preference.
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References
Sorokin I, Mamoulakis C, Miyazawa K et al (2017) Epidemiology of stone disease across the world. World J Urol 35(9):1301–1320
Assimos D (2016) Surgical management of stones: american urological association/endourological society guideline. PART I J Urol 196(4):1153–1160
Skolarikos A (2015) Outcomes of flexible ureterorenoscopy for solitary renal stones in the croes urs global study. J Urol 194(1):137–143
Bozzini G (2017) A prospective randomized comparison among SWL, PCNL and RIRS for lower calyceal stones less than 2 cm: a multicenter experience : a better understanding on the treatment options for lower pole stones. World J Urol 35:1967–1975
Fuchs GJ (2006) Milestones in endoscope design for minimally invasive urologic surgery: the sentinel role of a pioneer. Surg Endosc. https://doi.org/10.1007/s00464-006-0078-4
Marshall VF (1964) Fiber optics in urology. J Urol 91(1):64066–64073
Bagley DH, Rittenberg MH (1986) Percutaneous antegrade flexible ureteroscopy. Urology 27(4):331–334
Butticè S, Sener TE, Netsch C et al (2016) LithoVueTM: a new single-use digital flexible ureteroscope. Cent European J Urol 69(3):302–305
Lusch A (2013) In vitro and in vivo comparison of optics and performance of a distal sensor ureteroscope versus a standard fiberoptic ureteroscope. J Endourol 27(7):896–902
Monga M, Hendlin K, Skenazy J et al (2004) A novel dual-diameter ureteroscope working channel: impact on irrigant flow. Urol 64(5):892–894
Isaacson D (2017) Defining the costs of reusable flexible ureteroscope reprocessing using time-driven activity-based costing. J Endourol 31(10):1026–1031
Monga M (2006) Durability of flexible ureteroscopes: a randomized, prospective study. J Urol. https://doi.org/10.1016/S0022-5347(06)00575-1
Chang CL, Su LH, Lu CM et al (2013) Outbreak of ertapenem-resistant Enterobacter cloacae urinary tract infections due to a contaminated ureteroscope. J Hosp Infect 85(2):118–124
Davis NF, Mcgrath S, Quinlan M et al (2018) Carbon footprint in flexible ureteroscopy: a compar-ative study on the environmental impact of reusable and single-use ureteroscopes. J Endourol 32(3):214–217
Mager R, Kurosch M, Höfner T et al (2018) Clinical outcomes and costs of reusable and single-use flexible ureterorenoscopes: a prospective cohort study. Urolithiasis 46(6):587–593
Hennessey DB, Fojecki GL, Papa NP et al (2018) Single-use disposable digital flexible ureteroscopes: an ex vivo assessment and cost analysis. BJU Int 121:55–61
Legemate JD (2019) Durability of flexible ureteroscopes: a prospective evaluation of longevity, the factors that affect it, and damage mechanisms. Eur Urol Focus 5(6):1105–1111
Mrkobrada M (2015) CUA guidelines on antibiotic prophylaxis for urologic procedures. Can Urol Assoc J 9(1–2):13–22
Moore B, Proietti S, Giusti G et al (2019) Single-use ureteroscopes. Urol Clin North Am 46(2):165–174
Carey RI, Martin CJ, Knego JR (2014) Prospective evaluation of refurbished flexible ureteroscope durability seen in a large public tertiary care center with multiple surgeons. Urology 84(1):42–45
Abraham JBA (2007) Rapid communication: effects of Steris 1 sterilization and Cidex ortho-phthalaldehyde high-level disinfection on durability of new-generation flexible ureteroscopes. J Endourol 21(9):985–992
Martin CJ (2017) The economic implications of a reusable flexible digital ureteroscope: a cost-benefit analysis. J Urol 197(3):730–735
Taguchi K (2018) Micro-costing analysis demonstrates comparable costs for lithovue compared to reusable flexible fiberoptic ureteroscopes. J Endourol 32(4):267–273
Ofstead CL, Heymann OL, Quick MR et al (2017) The effectiveness of sterilization for flexible ureteroscopes: a real-world study. Am J Infect Control 45(8):888–895
Carey RI, Gomez CS, Maurici G et al (2006) Frequency of ureteroscope damage seen at a tertiary care center. J Urol. https://doi.org/10.1016/j.juro.2006.03.059
Wendt-Nordahl G, Mut T, Krombach P et al (2011) Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors? Urol Res 39(3):185–188
Mourmouris P (2021) Comparison of a single-use, digital flexible ureteroscope with a reusable, fiberoptic ureteroscope for management of patients with urolithiasis. Arch Ital Urol Androl 93(3):326–329
José A, Salvadó JM et al (2019) Endoscopic treatment of lower pole stones: is a disposable ureteroscope preferable? results of a prospective case-control study. Cent Eur J Urol 72(3):280
Takazawa R (2022) development of microscopy apparatus switchable between fluorescence and ultralow-frequency raman modes. J Anal Methods Chem. https://doi.org/10.1155/2022/2694545
Huang F (2022) Reusable digital flexible ureteroscope to treat upper urinary calculi: a propensity-score matching analysis. Front Surg. https://doi.org/10.3389/fsurg.2021.778157
Baboudjian MBM (2021) Single use versus reusable flexible ureteroscopy for the treatment of urolithiasis: a comparative study of perioperative complications. Urology 1:66–69
Li Y (2021) Comparison of single-use and reusable flexible ureteroscope for renal stone management: a pooled analysis of 772 patients. Transl Androl Urol 10(1):483–493
Usawachintachit M (2017) A prospective case-control study comparing lithovue, a single-use, flexible dis- posable ureteroscope, with flexible reusable fiber-optic ureteroscopes. J Endourol 31(5):468–475
Salman MY, Bayar G, Dincer HR et al (2021) Comparison of reusable and single-use ureteroscopes for the treatment of medium-sized stones in the lower calyx: a prospective randomized study. Ann Clin Anal Med. https://doi.org/10.4328/ACAM.20446
Kam J (2019) Single use versus reusable digital flexible ureteroscopes: a prospective comparative study. Int J Urol 26(10):999–1005
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MB and JPO wrote the main manuscript text, MB JA and CC worked on data analysis, ELAA and LSM prepared figures and tables. All authors reviewed the manuscript.
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Belkovsky, M., Passerotti, C.C., Maia, R.S. et al. Comparing outcomes of single-use vs reusable ureteroscopes: a systematic review and meta analysis. Urolithiasis 52, 37 (2024). https://doi.org/10.1007/s00240-024-01537-8
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DOI: https://doi.org/10.1007/s00240-024-01537-8