Category: Clinical Stones: Ureteroscopy
Introduction & Objective : Flexible ureteroscopy (URS) is a common treatment for patients with upper tract calculi. Flexible ureteroscopes are fragile devices, with known breakage rates. Recently, digital single-use flexible ureteroscopes have been introduced. We performed a study to assess how selective utilization of a single use ureteroscope could affect repair costs of reusable flexible ureteroscopes in an endourologic practice.
Between July 1, 2016, and June 30, 2017, we tracked URS procedures performed at a single community hospital with both reusable (Karl Storz Flex X2) and single-use (Boston Scientific LithoVue) flexible ureteroscopes. For the first six months of the study, all URS procedures were performed with the reusable scope. For the second six months of the study, the single-use scope was used selectively for patients with stone burdens >1.5cm in any location, >1cm in lower pole, or bilateral procedures. Patient and stone parameters were recorded, as well as breakage/repair of the reusable flexible ureteroscopes.
A total of 280 flexible URS procedures were performed; 148 between July 1, 2016 and December 31, 2016 (reusable flexible ureteroscope only), and 132 between January 1, 2017 and June 30, 2017 (selective utilization of single-use ureteroscope). Patient and stone parameters were comparable between the two groups; average stone size in first time period was 1.1cm and in second time period was 1.2cm (p>0.05). Most procedures were performed without a ureteral access sheath, and with a dusting approach. In the first six months, a total of 13 ureteroscope repairs were required; in the second six months, a total of 9 ureteroscope repairs were required. Based on contracted purchase and repair costs, this yielded a net savings of $10,604.
Selective utilization of a single-use ureteroscope can reduce breakage of reusable flexible ureteroscopes. At present, a complete conversion to a single-use ureteroscope platform for all URS procedures may be too great a cost for many institutions. However, selective utilization of a single-use ureteroscope may yield institutional cost savings, as repair costs can be reduced.
Kevin Koo– Fellow, Johns Hopkins University School of Medicine, Baltimore, Maryland
Michael Gorin– Assistant Professor of Urology, Oncology, and Radiology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
Rishab Gurnani– Baltimore, Maryland
Brian Matlaga– Baltimore, Maryland
Johns Hopkins University School of Medicine
Kevin Koo, MD, MPH, MPhil, is a fellow in endourology and minimally-invasive urological surgery at the Brady Urological Institute, Johns Hopkins University School of Medicine. He serves as national chair of the AUA Residents and Fellows Committee and is the AUA H. Logan Holtgrewe Legislative Fellow. He is a graduate of the Yale School of Medicine and completed residency at Dartmouth-Hitchcock Medical Center.
Assistant Professor of Urology, Oncology, and Radiology
The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine