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Comparative medico-economic study of reusable vs. single-use flexible ureteroscopes

  • Urology - Original Paper
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Abstract

Purpose

Reusable flexible-ureteroscopes (fURS) require personnel and budget for processing and repairing, whereas single-use fURS were recently developed. After exclusive reusable fURS since 2011, we experienced high repair costs and single-use fURS were therefore introduced in mid-2017. We aimed to evaluate economic and practical advantages and disadvantages of reusable versus single-use fURS.

Materials and methods

First, we evaluated the incidence of breakage and repairs of reusable fURS in 2017. We assessed the overall operational costs of reusable fURS including purchase, processing, and repairing in our institution from 2011 to 2017. Following our experience, we created a model to compare operation costs/procedure of single-use fURS with reusable fURS depending on repair costs.

Results

In 2017, repair costs of reusable fURS increased by 345% compared with the period 2011–2016, causing: a median unavailability per reusable fURS of 200 days/year (100–249), median number of functioning fURS 0/5–3/5 per operating day, while unavailability of reusable fURS had become the first reason for cancellation of procedure. Since it was introduced, single-use fURS accounted for 59% of the flexible ureteroscopy activity. Taking into account the costs of processing, maintenance and repair, in 2011–2016 versus 2017, the single-use fURS was cost-effective compared with the reusable fURS until the 22nd procedure versus the 73rd procedure, respectively.

Conclusions

After years of exclusive reusable fURS, the rising incidence of breakage not only increased maintenance costs but also hampered daily activity owing to unavailability of the devices. The introduction of single-use with reusable fURS provided substantial help to maintain our activity.

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References

  1. Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M et al (2016) EAU guidelines on interventional treatment for urolithiasis. Eur Urol mArs 69(3):475–482

    Article  Google Scholar 

  2. Rouprêt M, Babjuk M, Compérat E, Zigeuner R, Sylvester RJ, Burger M et al (2018) European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2017 update. Eur Urol 73(1):111–122

    Article  Google Scholar 

  3. Seisen T, Peyronnet B, Dominguez-Escrig JL, Bruins HM, Yuan CY, Babjuk M et al (2016) Oncologic outcomes of kidney-sparing surgery versus radical nephroureterectomy for upper tract urothelial carcinoma: a systematic review by the EAU non-muscle invasive bladder cancer guidelines panel. Eur Urol 70(6):1052–1068

    Article  Google Scholar 

  4. 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

    Article  Google Scholar 

  5. Ofstead CL, Heymann OL, Quick MR, Johnson EA, Eiland JE, Wetzler HP (2017) The effectiveness of sterilization for flexible ureteroscopes: a real-world study. Am J Infect Control. 45(8):888–895

    Article  Google Scholar 

  6. Sabnis RB, Bhattu A, Vijaykumar M (2014) Sterilization of endoscopic instruments. Curr Opin Urol 24(2):195–202

    Article  Google Scholar 

  7. Karaolides T, Bach C, Kachrilas S, Goyal A, Masood J, Buchholz N (2013) Improving the durability of digital flexible ureteroscopes. Urology 81(4):717–722

    Article  Google Scholar 

  8. 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 (discussion 610)

    Article  Google Scholar 

  9. 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

    Article  Google Scholar 

  10. Legemate JD, Kamphuis GM, Freund JE, Baard J, Zanetti SP, Catellani M, et al. Durability of flexible ureteroscopes: a prospective evaluation of longevity, the factors that affect it, and damage mechanisms. Eur Urol Focus. 2018

  11. Marchini GS, Batagello CA, Monga M, Torricelli FCM, Vicentini FC, Danilovic A et al (2018) In vitro evaluation of single-use digital flexible ureteroscopes: a practical comparison for a patient-centered approach. J Endourol 32(3):184–191

    Article  Google Scholar 

  12. Emiliani E, Mercadé A, Millan F, Sánchez-Martín F, Konstantinidis CA, Angerri O (2018) First clinical evaluation of the new single-use flexible and semirigid Pusen ureteroscopes. Cent Eur J Urol. 71(2):208–213

    Google Scholar 

  13. Emiliani E, Traxer O (2017) Single use and disposable flexible ureteroscopes. Curr Opin Urol 27(2):176–181

    Article  Google Scholar 

  14. Davis NF, Quinlan MR, Browne C, Bhatt NR, Manecksha RP, D’Arcy FT et al (2018) Single-use flexible ureteropyeloscopy: a systematic review. World J Urol 36(4):529–536

    Article  CAS  Google Scholar 

  15. Doizi S, Kamphuis G, Giusti G, Andreassen KH, Knoll T, Osther PJ et al (2017) First clinical evaluation of a new single-use flexible ureteroscope (LithoVue™): a European prospective multicentric feasibility study. World J Urol 35(5):809–818

    Article  Google Scholar 

  16. Usawachintachit M, Isaacson DS, Taguchi K, Tzou DT, Hsi RS, Sherer BA et al (2017) A prospective case-control study comparing LithoVue, a single-use, flexible disposable ureteroscope, with flexible. Reusable Fiber-Optic Ureteroscopes. J Endourol. mai 31(5):468–475

    Google Scholar 

  17. Wang F, Yang Y, Chen H, Huang H, Huang W, Weng Z et al (2018) The application of a single-use fiberoptic flexible ureteroscope for the management of upper urinary calculi. Int Urol Nephrol 50(7):1235–1241

    Article  Google Scholar 

  18. Berardinelli F, De Francesco P, Marchioni M, Cera N, Proietti S, Hennessey D et al (2016) Infective complications after retrograde intrarenal surgery: a new standardized classification system. Int Urol Nephrol 48(11):1757–1762

    Article  Google Scholar 

  19. Kramolowsky E, McDowell Z, Moore B, Booth B, Wood N (2016) Cost analysis of flexible ureteroscope repairs: evaluation of 655 procedures in a community-based practice. J Endourol 30(3):254–256

    Article  Google Scholar 

  20. Lasselin J, Viart L, Lasselin-Boyard P, Raynal G, Saint F (2015) Flexible ureteroscope damages. Evaluation of university hospital service equipment. Progres En Urol J Assoc Francaise Urol Soc Francaise Urol. 25(5):265–273

    Article  CAS  Google Scholar 

  21. Davis NF, McGrath S, Quinlan M, Jack G, Lawrentschuk N, Bolton DM (2018) Carbon footprint in flexible ureteroscopy: a comparative study on the environmental impact of reusable and single-use ureteroscopes. J Endourol 32(3):214–217

    Article  Google Scholar 

  22. Lechevallier E, Saussine C, Traxer O, Mignard J-P (2008) Sterilization and disinfection of endoscopes in urology. Progres En Urol J Assoc Francaise Urol Soc Francaise Urol. 18(12):955–958

    Article  CAS  Google Scholar 

  23. Ozimek T, Schneider MH, Hupe MC, Wiessmeyer JR, Cordes J, Chlosta PL et al (2017) Retrospective cost analysis of a single-center reusable flexible ureterorenoscopy program: a comparative cost simulation of disposable fURS as an alternative. J Endourol 31(12):1226–1230

    Article  Google Scholar 

  24. Hennessey DB, Fojecki G, Papa N, Lawrentschuk N, Bolton D (2018) Single use disposable digital flexible ureteroscopes: an ex vivo assessment and cost analysis. BJU Int. 121:55–61

    Article  Google Scholar 

  25. Martin CJ, McAdams SB, Abdul-Muhsin H, Lim VM, Nunez-Nateras R, Tyson MD et al (2017) The economic implications of a reusable flexible digital ureteroscope: a cost-benefit analysis. J Urol 197(3 Pt 1):730–735

    Article  Google Scholar 

  26. Sung JC, Springhart WP, Marguet CG, L’Esperance JO, Tan YH, Albala DM et al (2005) Location and etiology of flexible and semirigid ureteroscope damage. Urology. 66(5):958–963

    Article  Google Scholar 

  27. Multescu R, Geavlete B, Geavlete P (2013) A new era: performance and limitations of the latest models of flexible ureteroscopes. Urology 82(6):1236–1239

    Article  Google Scholar 

  28. Chapman RA, Somani BK, Robertson A, Healy S, Kata SG (2014) Decreasing cost of flexible ureterorenoscopy: single-use laser fiber cost analysis. Urology 83(5):1003–1005

    Article  CAS  Google Scholar 

  29. Ozimek T, Cordes J, Wiessmeyer JR, Schneider MH, Hupe MC, Gilbert N et al (2018) Steep infundibulopelvic angle as a new risk factor for flexible ureteroscope damage and complicated postoperative course. J Endourol 32(7):597–602

    Article  Google Scholar 

  30. Breda A, Angerri O (2014) Retrograde intrarenal surgery for kidney stones larger than 2.5 cm. Curr Opin Urol. 24(2):179–183

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Urology and Kidney Transplantation, APHM, Conception University Hospital, Aix-Marseille University, 13005, Marseille, France

    Khalid Al-Balushi, Hélène Loubon, Michael Baboudjian, Floriane Michel, Pierre-Clément Sichez, Thomas Martin, Eugénie Di-Crocco, Sarah Gaillet, Veronique Delaporte, Akram Akiki, Gilles Karsenty, Eric Lechevallier & Romain Boissier

  2. APHM, Conception University Hospital, Central Pharmacy, Marseille, France

    Nathalie Martin

  3. Department of Pediatric Surgery, APHM, Timone University Hospital, Aix-Marseille University, Marseille, France

    Alice Faure

Authors
  1. Khalid Al-Balushi
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  2. Nathalie Martin
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  3. Hélène Loubon
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  4. Michael Baboudjian
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  5. Floriane Michel
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  6. Pierre-Clément Sichez
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  7. Thomas Martin
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  8. Eugénie Di-Crocco
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  9. Sarah Gaillet
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  11. Akram Akiki
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  12. Alice Faure
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  15. Romain Boissier
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Contributions

Romain Boissier had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Protocol/project development: Boissier, Lechevallier. Data collection or management: Al-Balushi, Martin, Loubon, Baboudjian. Data analysis: Boissier, Al-Balushi, Lechevallier. Manuscript writing/editing: Al-Balushi, Boissier. Manuscript revision for intellectual content: Michel, Sichez, Martin, Di-Crocco, Gaillet, Delaporte, Karsenty, Akiki, Faure.

Corresponding author

Correspondence to Romain Boissier.

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Al-Balushi, K., Martin, N., Loubon, H. et al. Comparative medico-economic study of reusable vs. single-use flexible ureteroscopes. Int Urol Nephrol 51, 1735–1741 (2019). https://doi.org/10.1007/s11255-019-02230-1

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