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Urolithiasis Feb 2018During the last decades, the surgical management of kidney stones benefited of many technological advances and one of them is the development of flexible ureteroscopy... (Review)
Review
During the last decades, the surgical management of kidney stones benefited of many technological advances and one of them is the development of flexible ureteroscopy (fURS). This tool, ancillary equipment such as graspers and baskets, and lithotripsy technique with Holmium:YAG laser underwent many improvements leading to a widening of its indications with diagnostic and therapeutic management of upper urinary tract pathologies such as urolithiasis and urothelial tumors. The objective of this review is to describe the surgical technique for fURS as well as tips and tricks for the treatment of renal stones.
Topics: Equipment Design; Humans; Kidney Calculi; Practice Guidelines as Topic; Ureteroscopes; Ureteroscopy
PubMed: 29222575
DOI: 10.1007/s00240-017-1030-x -
International Braz J Urol : Official... 2022Flexible ureteroscopy is a well-established method for treatment of urinary stones but flexible ureteroscopes are expensive and fragile devices with a very limited... (Review)
Review
UNLABELLED
Flexible ureteroscopy is a well-established method for treatment of urinary stones but flexible ureteroscopes are expensive and fragile devices with a very limited lifetime. Since 2006 with the advent of digital flexible ureteroscopes a great evolution has occurred. The first single-use flexible ureteroscope was launched in 2011 and new models are coming to the market. The aim of this article is to review the characteristics of these devices, compare their results with the reusable devices and evaluate the cost-benefits of adopting single-use flexible ureteroscopes in developing countries.
MATERIALS AND METHODS
an extensive review of articles listed at PubMed and published between 2000 and 2021 was performed.
RESULTS
Single-use flexible ureteroscopes have a shaft with 65 to 68cm length and weight between 119 and 277g. Their deflection goes up to 300 degrees. Their stone-free rates vary between 60 and 95% which is comparable to reusable scopes and operative times ranges from 54 to 86 minutes which are lower when compared to reusable flexible scopes. Their costs vary between 800 and 3180 US dollars.
CONCLUSION
single-use flexible ureteroscopes are lighter and have superior quality of image when compared to fiberoptic ones. There are no definite data showing a higher stone-free rate or less complications with the use of single-use flexible ureteroscopes. Each institution must perform a cost-benefit analysis before making the decision of adopting or not such devices depending on the local circumstances.
Topics: Developing Countries; Equipment Design; Humans; Ureteroscopes; Ureteroscopy; Urolithiasis
PubMed: 34786927
DOI: 10.1590/S1677-5538.IBJU.2021.0475 -
Urology Jun 2022Flexible ureteroscopes are essential devices, and reusable models require meticulous cleaning and sterilization between procedures. Reprocessing is complex,... (Review)
Review
Flexible ureteroscopes are essential devices, and reusable models require meticulous cleaning and sterilization between procedures. Reprocessing is complex, time-consuming, and difficult due to the instrument's small size, fragility, and internal channel. The Food and Drug Administration recently raised concerns about the effectiveness of ureteroscope reprocessing. Due to inadequate reprocessing and maintenance, contaminated and damaged ureteroscopes pose risks to patient safety. This review describes ureteroscope reprocessing methods and summarizes evidence on reprocessing effectiveness and documented outcomes associated with the use of damaged or inadequately cleaned and sterilized ureteroscopes.
Topics: Equipment Design; Equipment Reuse; Humans; Ureteroscopes
PubMed: 35123986
DOI: 10.1016/j.urology.2022.01.033 -
International Braz J Urol : Official... 2022
Topics: Developing Countries; Equipment Design; Humans; Ureteroscopes; Ureteroscopy
PubMed: 35373945
DOI: 10.1590/S1677-5538.IBJU.2021.0475.1 -
Research and Reports in Urology 2017The field of ureteroscopy has undergone a continual evolution since the first ureteroscopes were introduced. Over the past 10 years, we have entered into the digital era... (Review)
Review
The field of ureteroscopy has undergone a continual evolution since the first ureteroscopes were introduced. Over the past 10 years, we have entered into the digital era of ureteroscopy with both semirigid and flexible options becoming available. The following review looks at the benefits and drawbacks of digital flexible ureteroscopes as well as the current commercially available options.
PubMed: 28203551
DOI: 10.2147/RRU.S104229 -
International Journal of Surgery... Dec 2016The advancements in the endourological armamentarium and the evolution of ureteroscopes with the advent of fiberoptic first and then digital technology, the introduction... (Review)
Review
The advancements in the endourological armamentarium and the evolution of ureteroscopes with the advent of fiberoptic first and then digital technology, the introduction of holmium laser lithotripters, together with the increasing number of requests for minimally invasive procedures has ameliorated outcomes, patients' safety and comfort, making the use of flexible ureteroscopy for urinary calculi increasingly attractive and widespread among urological community. Due to its high stone-free rates and low morbidity, flexible ureteroscopy has become a viable option for the treatment of renal stones. This review describes the contemporary ureteroscopic management of kidney stones.
Topics: Humans; Kidney Calculi; Lithotripsy; Patient Safety; Ureteroscopes; Ureteroscopy
PubMed: 27913238
DOI: 10.1016/j.ijsu.2016.11.130 -
Research and Reports in Urology 2021The technological advancements of flexible ureteroscopy (FURS) and its accessories have resulted in broadening its indications to include the management of complex renal... (Review)
Review
The technological advancements of flexible ureteroscopy (FURS) and its accessories have resulted in broadening its indications to include the management of complex renal stones, with long operative time. The surgeon's understanding about the ergonomics of the ureteroscopes and their cognizance of the operation theatre layout helps to improve their performance, including the surgical outcomes. This paper will describe the ergonomics that are involved in conducting FURS which in turn will aid in developing a more conducive surgical environment for the surgeon during the procedure, based on scientific literature review and expert opinions in high-volume centres. Proper surgeon position, well-arranged operation theatre layout, monitor and pedal position, anaesthesia type, and surgical team are important factors to decrease musculoskeletal strains for surgeons and increase work efficiency. Different types of flexible ureteroscope have different characters and knowing these special characters leads to better ergonomics during surgery. Robotic-assisted FURS have shown good safety and ergonomics in clinical application.
PubMed: 34235098
DOI: 10.2147/RRU.S317347 -
BJUI Compass Nov 2023Single use ureteroscopes are a technological innovation that have become available in the past decade and gained increased popularity. To this end, there are now an... (Review)
Review
INTRODUCTION
Single use ureteroscopes are a technological innovation that have become available in the past decade and gained increased popularity. To this end, there are now an increasing number of both benchside and clinical studies reporting outcomes associated with their use. Our aim was to deliver a narrative review in order to provide an overview of this new technology.
METHODS
A narrative review was performed to gain overview of the history of the technology's development, equipment specifications and to highlight potential advantages and disadvantages.
RESULTS
Findings from preclinical studies highlight potenial advantages in terms of the design of single use ureteroscopes such as the lower weight and more recent modifications such as pressure control. However, concerns regarding plastic waste and environmental impact still remain unanswered. Clinical studies reveal them to have a non inferior status for outcomes such as stone free rate. However, the volume of evidence, especially in terms of randomised trials remains limited. From a cost perspective, study conclusions are still conflicting and centres are recommended to perform their own micro cost analyses.
CONCLUSIONS
Most clinical outcomes for single use ureteroscopes currently match those achieved by reusable ureteroscopes but the data pool is still limited. Areas of continued debate include their environmental impact and cost efficiency.
PubMed: 37818020
DOI: 10.1002/bco2.265 -
Medicina (Kaunas, Lithuania) Oct 2022: Disposable flexible ureteroscopes have been widely used because of their cost-effectiveness and higher sterility potential compared with reusable flexible... (Meta-Analysis)
Meta-Analysis Review
: Disposable flexible ureteroscopes have been widely used because of their cost-effectiveness and higher sterility potential compared with reusable flexible ureteroscopes. This study aimed to compare the surgical outcomes and complication rates in patients who undergo reusable or disposable flexible ureteroscopic stone surgeries (fURS) for urinary stone disease. : A systematic review and meta-analysis were conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. This systematic review was registered with PROSPERO (CRD42022331291). Clinical trials comparing reusable and disposable fURS for stone disease were found from PubMed, EMBASE, Cochrane Library, and the Web of Science up to March 2022. Participants were patients with upper urinary tract stones; the interventions were reusable or disposable fURS. Outcomes, including stone-free rate, operation time, length of hospital stay, and complication rate, were compared for analysis. : Overall, 111 studies were identified, but after removing duplicate studies, 75 studies remained. Thirty-two of these studies were excluded. Of the 43 screened studies, 11 met the eligibility criteria. There was no difference in the stone-free rate (SFR) between disposable and reusable fURS ( = 0.14; OR = 1.36; 95% CI, 0.9 to 2.04). For operation time, no difference was identified between reusable and disposable fURS groups ( = 0.12; MD = -5.31; 95% CI, -12.08 to 1.46). For hospital stay, there was also no difference between the two groups ( = 0.61; MD = -0.03; 95% CI, -0.17 to 0.10). There was no significant difference in complication rate between the two groups ( = 0.85; OR = 0.95; 95% CI, 0.56 to 1.61). : There were no differences in the SFR, operation time, length of hospital stay, and complication rate between reusable and disposable fURS. Disposable fURS may be a comparable alternative to reusable fURS.
Topics: Humans; Ureteroscopes; Equipment Design; Kidney Calculi; Ureteroscopy; Urinary Calculi; Treatment Outcome
PubMed: 36295549
DOI: 10.3390/medicina58101388