Category: Clinical Stones: Ureteroscopy

MP32-6 - Perioperative Outcomes of Ureteroscopic Laser Lithotripsy with a Single-Use Disposable Ureteroscope

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

While Reusable flexible ureteroscopes (RU) are commonly used for laser lithotripsy, but are criticized for limited durability resulting in unpredictable performance and costly repairs. As such, single-use disposable ureteroscopes (DU) present an alternative that may eliminate the costs and delays associated with RU damage. As such, we seek to compare perioperative outcomes of ureteroscopic laser lithotripsy with use of DU compared to RU.


Methods :

We identified 203 adult patients who underwent ureteroscopy with laser lithotripsy and/or stone extraction 3/2017 – 2/2018 performed by a single fellowship trained Endourologist. Cases were excluded if a semi-rigid ureteroscope was used or if bilateral ureteroscopy was performed. DU procedures utilized the LithoVue single-use disposable digital ureteroscope (Boston Scientific, USA); RU procedures utilized the Flex2s fiber optic reusable ureteroscope (Karl Storz, Germany). Procedural and clinical outcomes including operative time, complication rates and unplanned visit rates were recomrded from the medical record.  Stone free was defined as no residual stone (0mm) on follow up imaging (CT or ultrasound). Patients were grouped by ureteroscope type and compared across groups<./p>


Results : 97 cases met inclusion criteria, and of these 24 (24.7%) cases utilized DU. Patients in the DU group had a higher median stone burden (15.5mm vs 9mm, p<0.01), and more frequently had ASA score ≥ 3 (50.0% vs 24.7%, p=0.02) (Table). DU patients had a longer median operative time (34min vs 23 min, p<0.01). Among those with follow-up imaging available (n=74) a stone free rate of 32.4% was noted. The DU group had lower stone free rates (15.8% vs 32.8%, p=0.09), and higher median residual stone burden (8mm vs 5mm, p=0.22). Similar rates of unplanned postoperative encounters were noted in both groups (Table).

 


Conclusions :

In this cohort, DU was used in cases with a median stone burden of 15mm. While lower stone free rates and larger residual stone burden were noted among the DU group, this likely due to the increased complexity of DU cases. Further studies are warranted to compare outcomes of DU and RU in complex cases, using more homogenous treatment arms. Secondarily, overall stone free rates were lower than reported data which may be due to the strict stone free criteria utilized. As our data matures, we will report on the stone free classification using intraoperative vs radiographic reporting.

Ohad Kott

Research Fellow
Minimally Invasive Urology Institute, The Miriam Hospital; The Warren Alpert Medical School at Brown University, Division of Urology
Providence, Rhode Island

Ohad Kott, MD, MHA. Research Fellow, Minimally Invasive Urology Institute, The Miriam Hospital; The Warren Alpert Medical School at Brown University, Providence, RI USA. Dr. Kott earned his undergraduate and graduate degrees in medical science from Sackler Medical School at Tel-Aviv University where he later completed his medical education. Prior to getting his MD, he earned his MBA and graduated cum laude with his Masters in Health Administration from Tel-Aviv University. His main fields of interest are endourology and urologic oncology.

Jorge Pereira

Minimally Invasive Urology Fellow
Minimally Invasive Urology Institute, Alpert Medical School at Brown University
Providence, Rhode Island

Timothy Wright

Medical Student
Warren Alpert School of Medicine at Brown University
Providence, Rhode Island

Eric Jung

Resident
Department of Urology, Warren Alpert School of Medicine at Brown University
Providence, Rhode Island

Meredith Wasserman

Resident
Department of Urology, Warren Alpert School of Medicine at Brown University
Providence, Rhode Island

Alejandra Balen

Resident
Department of Urology, Warren Alpert School of Medicine at Brown University
Providence, Rhode Island

Paul Bower

Resident
Department of Urology, Warren Alpert School of Medicine at Brown University
Providence, Rhode Island

Mina Ghaly

Undegraduate Student/Research Assistant - Minimally Invasive Urology Institute, The Miriam Hospital

Christopher Tucci

Program Manager
Minimally Invasive Urology Institute, The Miriam Hospital
Providence, Rhode Island

Gyan Pareek

Associate Professor of Surgery (Urology), Director of Minimally Invasive Urologic Surgery
Minimally Invasive Urology Institute, Alpert Medical School at Brown University
Providence, Rhode Island