PD45-05 COMPARATIVE ANALYSIS OF PHYSICAL AND OPTICAL PROPERTIES OF SINGLE-USE VERSUS REUSABLE URETERORENOSCOPES FOR RETROGRADE INTRARENAL SURGERY (RIRS)
2018-04-01

You have accessJournal of UrologyStone Disease: Surgical Therapy III1 Apr 2018PD45-05 COMPARATIVE ANALYSIS OF PHYSICAL AND OPTICAL PROPERTIES OF SINGLE-USE VERSUS REUSABLE URETERORENOSCOPES FOR RETROGRADE INTRARENAL SURGERY (RIRS) Susanne Deininger, Stephan Kruck, Luis Haberstock, Jens Bedke, Tilman Todenhoefer, Eva Neumann, Arnulf Stenzl, and Steffen Rausch Susanne DeiningerSusanne Deininger More articles by this author , Stephan KruckStephan Kruck More articles by this author , Luis HaberstockLuis Haberstock More articles by this author , Jens BedkeJens Bedke More articles by this author , Tilman TodenhoeferTilman Todenhoefer More articles by this author , Eva NeumannEva Neumann More articles by this author , Arnulf StenzlArnulf Stenzl More articles by this author , and Steffen RauschSteffen Rausch More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2141AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Retrograde intrarenal surgery (RIRS) represents a standard procedure for kidney stone removal, especially in stone sizes up to 2cm. However, due to material wear, RIRS is considered as a cost intensive procedure. Recently, single-use flexible ureterorenoscopes have been introduced to improve budget predictability in RIRS, while influence on operative quality and risk of complications using these devices warrants further evaluation. In the present experimental study, we aimed to assess differences in physical and optical properties of single-use devices in comparison to standard reusable endoscopes. METHODS In two single-use (LithoVue single-use digital flexible ureterorenoscope, Boston Scientific; Pusen Uscope UE3011, Medical Video Endoscope), and one reusable ureterorenoscope (Flex-Xc, Karl-Storz Endoscopes), we investigated flow rates, flexion, illuminance, and intrarenal pressure in a porcine kidney model. Subjective image quality was assessed using a standardized questionnaire. Common insertable devices (Zero Tip stone basket, Boston Scientific; Sensor guide wire, Boston Scientific; 365micm laser fiber) were applied to investigate additional influence on physical properties. RESULTS Significant variability in maximum flow rates was observed between the endoscopes (Pusen: 33.4 ml/min, LithoVue: 30.3 ml/min, Flex-Xc: 25.8 ml/min, P<0.05). Application of a guide wire into the working channel resulted in the highest reduction of flow rates (Pusen: 2.1 ml/min, LithoVue: 1.93 ml/min, Flex-Xc: 1.2 ml/min), and maximum flexion in both directions in all ureteroscopes. Flexion led to a reduction of up to 7.9% of absolute flow rates (Pusen). During instrumentation, maximum intranenal pressure was measured with 90 cmH2O (Pusen) as compared to 51cmH2O and 40cmH2O (LithoVue; Flex-Xc), respectively. Illumination at 20mm / 50mm distance were 2160 lux / 428 lux (Pusen), 9090 lux / 1857 lux (Flex-Xc) and 5733 lux/ 1032 lux (LithoVue), respectively (p<0.05). Subjective image quality score was highest (24.1) using the Flex-Xc endoscope as compared to LithoVue (21.0) and Pusen (20.1). CONCLUSIONS Despite economic issues regarding the choice of either single-use or reusable flexible ureterorenoscopes, significant differences in physical and optical properties are present, with putative influence on surgical efficacy, complications, and patient outcome. Further comparative evaluation of single-use and reusable endoscopes in a clinical scenario is useful. With regard to high intrarenal pressure during RIRS, utilization of ureteral access sheaths may be considered to avoid renal damage. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e887 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Susanne Deininger More articles by this author Stephan Kruck More articles by this author Luis Haberstock More articles by this author Jens Bedke More articles by this author Tilman Todenhoefer More articles by this author Eva Neumann More articles by this author Arnulf Stenzl More articles by this author Steffen Rausch More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...