Category: Clinical Stones: Ureteroscopy
Introduction & Objective :
Flexible ureteroscopes (pyeloscopes) have become an integral part of upper tract procedures in urology. However, their fragility remains a problem with high costs of repair for breakage, and the new availability of single use ureteroscopes raises the issue of cost-effectiveness. Conflicting data exists for the rates of flexible ureteroscope failure and the potential causal factors. In this study we systematically evaluated across three hospitals the cost of repair and rate of damage amongst flexible ureteroscopes, and aimed to identify any contributing factors.
Flexible ureteroscope usage across all Geelong (Victoria, Australia) hospitals - University Hospital Geelong Hospital, St John of God Hospital Geelong and Geelong Private Hospital, was studied prospectively. All consecutive procedures involving the use of a flexible ureteroscope over a 30 month period were included. Structured questionnaires were issued to proceduralists, theatre nurses and sterilisation personnel immediately after each case. Details regarding indication for use, operative duration, difficulty, visibility, manoeuvrability, as well as use of instruments in the working channel and access sheath were collected. Utilising maintenance records, flexible ureteroscope damage and subsequent repair/replacement costs were analysed. Data analysis was conducted using appropriate statistical techniques.
733 procedural cases involving flexible ureteroscopes were recorded, of which 42 instances of scope damage occurred (17.5 uses per case). Repair and replacement costs totalled $184,879 (AUD) with an average of $252 per case across all procedures and median $7,000 per billable episode. Damaged scopes were unavailable for use for 17 days (IQR 7-32). Lifetime data was available for 38 scopes used in 515 procedures and a total of 301 hours of use. 26 scopes were damaged sufficiently to require total replacement during the investigation period. Survival curve analysis revealed an overall median scope lifetime of 8.9 hrs (IQR 4.5-13.5). No significant differences in experience level of user, indication, lesion location, usage time, access sheath use, instrumental channel use or subjective visibility and manoeuvrability were identified between damaged and undamaged cases. In addition, there was no significant difference in damage rates between the different sites.
Flexible ureteroscope damage occurs in our local service at a rate of once per 17.5 cases, with a repair and replacement cost equivalent to $252 (AUD) per case and contrary to other published series our large prospective study shows no specific identifiable operative or proceduralist factors.
Richard Grills– Director of Urology, Barwon Health, University Hospital Geelong, Victoria, Australia, Geelong, Victoria, Australia
Sita Murugappan– Melbourne, Victoria, Australia
Matthew Morey– Melbourne, Victoria, Australia
Belinda Jennings– Geelong, Victoria, Australia
Matthew Hong– Geelong, Victoria, Australia
Eileen Moore– Research Fellow, Barwon Health, University Hospital, Geelong, Victoria, Australia., Geelong, Victoria, Australia
Director of Urology
Barwon Health, University Hospital Geelong, Victoria, Australia
Geelong, Victoria, Australia