Single-use versus reusable ureterorenoscopes for retrograde intrarenal surgery (RIRS): systematic comparative analysis of physical and optical properties in three different devices
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Retrograde intrarenal surgery (RIRS) represents a standard option for kidney stone removal. However, RIRS is considered a cost-intensive procedure. Single-use flexible ureterorenoscopes have been introduced to improve budget predictability in RIRS. We assessed differences in physical and optical properties of single-use devices compared to standard reusable endoscopes.
In two single-use (LithoVue™, Boston Scientific; Pusen Uscope UE3011™), and one reusable ureterorenoscope (Flex-Xc™, Karl Storz), we investigated flow rates, deflection, illuminance, and intrapelvic pressure in a porcine kidney model. Subjective image quality was assessed using a standardized questionnaire. Common insertable devices were applied to investigate additional influence on physical properties.
Significant variability in maximum flow rates was observed (Flex-Xc™: 25.8 ml/min, LithoVue™: 30.3 ml/min, Pusen™: 33.4 ml/min, p < 0.05). Insertion of a guide wire resulted in the highest reduction of flow rates in all endoscopes. Flection led to a reduction of absolute flow rates up to 9.4% (Flex-Xc™). Light intensity at 20/50 mm distance was 9090 lx/1857 lx (Flex-Xc™) and 5733 lx/1032 lx (LithoVue™) and 2160 lx/428 lx (Pusen™), respectively (p < 0.05). Subjective image quality score was highest using the Flex-Xc™ endoscope. During manipulation, maximum intrarenal pressure up to 66 mmHg (Pusen™) was measured.
Significant differences in physical and optical properties of single-use or reusable flexible ureterorenoscopes are present, with putative influence on surgical efficacy and complications. Further comparative evaluation of single-use and reusable endoscopes in a clinical scenario is useful. Moreover, utilization of ureteral access sheaths may be considered to avoid renal damage.
KeywordsSingle use Urolithiasis Kidney stone Ureterorenoscopy RIRS Flexible
SR., S.K., S.D.: Protocol development, S.D., L.H. S.R., S.K., E.N., I.C.: Data collection and experiments, S.R., S.D., T.T.: Data analysis and interpretation, A.S., J.B., S.K.: Study supervision, S.R., S.D, A.S.: Manuscript writing/editing, S.D., I.C.: Graphical design/figures.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study was approved by the institutional review board and conducted in accordance with the Helsinki Declaration and START protocol. We take responsibility to the integrity of the data and accuracy of the reported study. All authors have made a substantial contribution to the information or material submitted for publication and approved the final version.