Abstract
The purpose of this study is to analyze clinical outcomes and costs of single-use flexible ureterorenoscopes in comparison with reusable flexible ureterorenoscopes in a tertiary referral center. Prospectively, 68 flexible ureterorenoscopies utilizing reusable (Flex-X2S, Flex-XC, Karl Storz) and 68 applying single-use flexible ureterorenoscopes (LithoVue, Boston Scientific) were collected. Clinical outcome parameters such as overall success rate, complication rates according to Clavien–Dindo, operation time and radiation exposure time were measured. Cost analysis was based on purchase costs and recurrent costs for repair and reprocessing divided by number of procedures. In each group 68 procedures were available for evaluation. In 91% of reusable and 88% of single-use ureterorenoscopies stone disease was treated with a mean stone burden of 101 ± 226 and 90 ± 244 mm2 and lower pole involvement in 47 and 41%, respectively (p > 0.05). Comparing clinical outcomes of reusable vs. single-use instruments revealed no significant difference for overall success rates (81 vs. 87%), stone-free rates (82 vs. 85%), operation time (76.2 ± 46.8 vs. 76.8 ± 40.2 min), radiation exposure time (3.83 ± 3.15 vs. 3.93 ± 4.43 min) and complication rates (7 vs. 17%) (p > 0.05). A wide range of repair and purchase costs resulted in total to $1212–$1743 per procedure for reusable ureterorenoscopy whereas price of single-use ureterorenoscopy was $1300–$3180 per procedure. The current work provided evidence for equal clinical effectiveness of reusable and single-use flexible ureterorenoscopes. Partially overlapping ranges of costs for single-use and reusable scopes stress the importance to precisely know the expenses and caseload when negotiating purchase prices, repair prices and warranty conditions.
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References
Skolarikos A, Gross AJ, Krebs A, Unal D, Bercowsky E, Eltahawy E, Somani B, de la Rosette J (2015) Outcomes of Flexible ureterorenoscopy for solitary renal stones in the CROES URS global study. J Urol 194(1):137–143. https://doi.org/10.1016/j.juro.2015.01.112
BostonScientificCorporation (2016) LithoVue single-use digital flexible ureteroscope. LithoVue-Brochure. https://www.bostonscientific.com/content/dam/bostonscientific/uro-wh/portfolio-group/LithoVue/LithoVueProductShots/SupportingMaterials/LithoVue-Brochure.pdf. Accessed 20 Feb 2017
Doizi S, Kamphuis G, Giusti G, Andreassen KH, Knoll T, Osther PJ, Scoffone C, Perez-Fentes D, Proietti S, Wiseman O, de la Rosette J, Traxer O (2016) First clinical evaluation of a new single-use flexible ureteroscope (LithoVue): a European prospective multicentric feasibility study. World J Urol. https://doi.org/10.1007/s00345-016-1936-x
Proietti S, Dragos L, Molina W, Doizi S, Giusti G, Traxer O (2016) comparison of new single-use digital flexible ureteroscope versus nondisposable fiber optic and digital ureteroscope in a cadaveric model. J Endourol 30(6):655–659. https://doi.org/10.1089/end.2016.0051
Dale JA, Kaplan AG, Radvak D, Shin R, Ackerman A, Chen TT, Scales CD, Ferrandino MN, Simmons WN, Preminger GM, Lipkin ME (2016) Evaluation of a novel single-use flexible ureteroscope. J Endourol. https://doi.org/10.1089/end.2016.0237
Martin CJ, McAdams SB, Abdul-Muhsin H, Lim VM, Nunez-Nateras R, Tyson MD, Humphreys MR (2017) The economic implications of a reusable flexible digital ureteroscope: a cost-benefit analysis. J Urol 197(3 Pt 1):730–735. https://doi.org/10.1016/j.juro.2016.09.085
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Gurbuz C, Atis G, Arikan O, Efilioglu O, Yildirim A, Danacioglu O, Caskurlu T (2014) The cost analysis of flexible ureteroscopic lithotripsy in 302 cases. Urolithiasis 42(2):155–158. https://doi.org/10.1007/s00240-013-0628-x
Geraghty R, Jones P, Somani BK (2017) Worldwide trends of urinary stone disease treatment over the last two decades: a systematic review. J Endourol. https://doi.org/10.1089/end.2016.0895
Li ZG, Zhao Y, Fan T, Hao L, Han CH, Zang GH (2016) Clinical effects of FURL and PCNL with holmium laser for the treatment of kidney stones. Exp Ther Med 12(6):3653–3657. https://doi.org/10.3892/etm.2016.3835
Wilhelm K, Hein S, Adams F, Schlager D, Miernik A, Schoenthaler M (2015) Ultra-mini PCNL versus flexible ureteroscopy: a matched analysis of analgesic consumption and treatment-related patient satisfaction in patients with renal stones 10–35 mm. World J Urol 33(12):2131–2136. https://doi.org/10.1007/s00345-015-1585-5
Javanmard B, Razaghi MR, Ansari Jafari A, Mazloomfard MM (2015) Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for the treatment of renal pelvis stones of 10–20 mm in obese patients. J Lasers Med Sci 6(4):162–166. https://doi.org/10.15171/jlms.2015.12
Kumar A, Vasudeva P, Nanda B, Kumar N, Das MK, Jha SK (2015) A prospective randomized comparison between shock wave lithotripsy and flexible ureterorenoscopy for lower caliceal stones </=2 cm: a single-center experience. J Endourol 29(5):575–579. https://doi.org/10.1089/end.2013.0473
Dessyn JF, Balssa L, Chabannes E, Jacquemet B, Bernardini S, Bittard H, Guichard G, Kleinclauss F (2016) Flexible ureterorenoscopy for renal and proximal ureteral stone in patients with previous ureteral stenting: impact on stone-free rate and morbidity. J Endourol 30(10):1084–1088. https://doi.org/10.1089/end.2016.0045
Somani BK, Al-Qahtani SM, de Medina SD, Traxer O (2013) Outcomes of flexible ureterorenoscopy and laser fragmentation for renal stones: comparison between digital and conventional ureteroscope. Urology 82(5):1017–1019. https://doi.org/10.1016/j.urology.2013.07.017
Binbay M, Yuruk E, Akman T, Ozgor F, Seyrek M, Ozkuvanci U, Berberoglu Y, Muslumanoglu AY (2010) Is there a difference in outcomes between digital and fiberoptic flexible ureterorenoscopy procedures? J Endourol 24(12):1929–1934. https://doi.org/10.1089/end.2010.0211
Erbin A, Tepeler A, Buldu I, Ozdemir H, Tosun M, Binbay M (2016) External comparison of recent predictive nomograms for stone-free rate using retrograde flexible ureteroscopy with laser lithotripsy. J Endourol 30(11):1180–1184. https://doi.org/10.1089/end.2016.0473
Berardinelli F, Proietti S, Cindolo L, Pellegrini F, Peschechera R, Derek H, Dalpiaz O, Schips L, Giusti G (2016) A prospective multicenter European study on flexible ureterorenoscopy for the management of renal stone. Int Braz J Urol 42(3):479–486
Carey RI, Gomez CS, Maurici G, Lynne CM, Leveillee RJ, Bird VG (2006) Frequency of ureteroscope damage seen at a tertiary care center. J Urol 176(2):607–610. https://doi.org/10.1016/j.juro.2006.03.059 (discussion 610)
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. https://doi.org/10.1016/j.urology.2014.01.022
Collins JW, Keeley FX Jr, Timoney A (2004) Cost analysis of flexible ureterorenoscopy. BJU Int 93(7):1023–1026. https://doi.org/10.1111/j.1464-410X.2003.04774.x
Knudsen B, Miyaoka R, Shah K, Holden T, Turk TM, Pedro RN, Kriedberg C, Hinck B, Ortiz-Alvarado O, Monga M (2010) Durability of the next-generation flexible fiberoptic ureteroscopes: a randomized prospective multi-institutional clinical trial. Urology 75(3):534–538. https://doi.org/10.1016/j.urology.2009.06.093
Monga M, Best S, Venkatesh R, Ames C, Lee C, Kuskowski M, Schwartz S, Vanlangendock R, Skenazy J, Landman J (2006) Durability of flexible ureteroscopes: a randomized, prospective study. J Urol 176(1):137–141. https://doi.org/10.1016/S0022-5347(06)00575-1
Shah K, Monga M, Knudsen B (2015) Prospective randomized trial comparing 2 flexible digital ureteroscopes: ACMI/olympus invisio DUR-D and olympus URF-V. Urology 85(6):1267–1271. https://doi.org/10.1016/j.urology.2014.12.012
User HM, Hua V, Blunt LW, Wambi C, Gonzalez CM, Nadler RB (2004) Performance and durability of leading flexible ureteroscopes. J Endourol 18(8):735–738. https://doi.org/10.1089/end.2004.18.735
Landman J, Lee DI, Lee C, Monga M (2003) Evaluation of overall costs of currently available small flexible ureteroscopes. Urology 62(2):218–222
Somani BK, Robertson A, Kata SG (2011) Decreasing the cost of flexible ureterorenoscopic procedures. Urology 78(3):528–530. https://doi.org/10.1016/j.urology.2010.12.073
Muggeo E, Boissel A, Martin L, Sgro C, Michiels C (2015) Cost comparison of two reprocessing procedures of flexible ureteroscopes at the University Hospital of Dijon. Prog Urol 25(6):318–324. https://doi.org/10.1016/j.purol.2015.01.019
Semins MJ, George S, Allaf ME, Matlaga BR (2009) Ureteroscope cleaning and sterilization by the urology operating room team: the effect on repair costs. J Endourol 23(6):903–905. https://doi.org/10.1089/end.2008.0489
Sooriakumaran P, Kaba R, Andrews HO, Buchholz NP (2005) Evaluation of the mechanisms of damage to flexible ureteroscopes and suggestions for ureteroscope preservation. Asian J Androl 7(4):433–438. https://doi.org/10.1111/j.1745-7262.2005.00077.x
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R. Mager, M. Kurosch, T. Höfner, S. Frees, A. Haferkamp and A. Neisius declare that they have no conflict of interest.
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Axel Haferkamp and Andreas Neisius shared senior authorship.
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Mager, R., Kurosch, M., Höfner, T. et al. Clinical outcomes and costs of reusable and single-use flexible ureterorenoscopes: a prospective cohort study. Urolithiasis 46, 587–593 (2018). https://doi.org/10.1007/s00240-018-1042-1
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DOI: https://doi.org/10.1007/s00240-018-1042-1