V03-04: Bench and Clinical testing of Two Single Use and One Reusable Digital Ureterorenoscope
Flexible ureteroscopy is now the gold standard for management of most renal and proximal ureteral calculi. However, the cost associated with maintenance of these ureteroscopes can be prohibitive. The introduction of two new single use flexible digital ureteroscopes has provided a possible cost effective alternative to reusable scopes. The aim of this study was to evaluate the performance of these ureteroscopes.
The LithoVue (Boston Scientific) and Uscope (Pusen Medical) disposable ureteroscopes were compared to the Flex-XC (Storz) reusable scope on bench testing and clinically in the surgical management of renal calculi. A comprehensive investigation of bench parameters including deflection, tip and shaft diameter, color representation and imaging characteristics (distortion,resolution,field of view) was undertaken. Subsequently, the ureteroscopes were evaluated for performance in renal calculus patients.Visualization,access to calyces and ease of use of accessories including laser fibers and stone baskets were compared.
Deflection of the LithoVue and Uscope devices compared favorably to the reusable scope both with the working channel empty and in use. They were comparable to the Flex- XC reusable scope with respect to image distortion. The LithoVue demonstrated superior deflection and irrigation flow while the Uscope showed better color representation and field of view. The Flex- XC had the best image resolution. In vivo, all scopes were able to access the upper, mid and lower poles with equal ease. Visibility was comparable among the scopes on access to the collecting system and while performing laser lithotripsy and basket extraction of stones.
The two single use flexible digital ureteroscopes are comparable to an existing reusable scope in maneuverability, visualization of the collecting system and ease of use of accessories. The disposable scopes are particularly useful in treating difficult to access calculi since there is less concern for ureteroscope damage. The choice of ureteroscope will depend on the type of case anticipated and the economic considerations of a given urologist or institution.