Category: Clinical Stones: Ureteroscopy
Introduction & Objective : Flexible ureteroscopy is an important modality in the treatment of benign and malignant conditions of the upper urinary tract. While the durability and versatility of flexible scopes have increased considerably, repair costs remain high and time out of commission slows work. Our institution experienced damage to 75 flexible ureteroscopes (fURS) in a 27-month timespan. After purchasing new digital fURS, we studied how and when these instruments were being damaged. Our study aimed to assess the timing and variables associated with damage to fURS at our institution.
Between Sept. 1, 2017 and Mar. 31, 2018 we performed leak testing on flexible ureteroscopes both before and after use. We gathered intraoperative data, including resident level, surgical indication, laser time, laser energy, and disposable tools used in all cases that employed a digital or fiber optic fURS. The manufacturer additionally provided us with details of each fURS repair in order to better understand the cause. Categorical and continuous variables were analyzed to identify risk factors for intraoperative fURS damage.
During the study period, complete data was gathered for 168 cases.Thirteen fURS failed leak testing indicating an overall leak failure rate of 8%. Of these, ten failed leak testing preoperatively indicating non-operative damage occurring sometime during transport, handling, or sterile processing. The other three failures occurred during the procedures. The intraoperative failures were associated with longer laser times (95min vs. 5min, p-value=0.02) and higher Wattage (33kJ vs. 0.5kJ, p-value=0.02).
Conclusions : Our institutional leak failure rate is 8%. The majority of these failures did not occur during surgery. Of the three that occurred during surgery, longer laser time and higher wattage appeared to be a factor. We are continuing to study how the non-operative failures occur and how these can be minimized.
Margaret Higgins– Urology Resident, University of Kentucky, Lexington, Kentucky
Adam Dugan– University of Kentucky, Lexington, Kentucky
Andrew Harris– Endourology/Robotics Fellow, University of Kentucky, Lexington, Kentucky
John Roger Bell– Assistant Professor, University of Kentucky, Lexington, Kentucky
Jason Bylund– Associate Professor, University of Kentucky, Lexington, Kentucky
Amul Bhalodi– Assistant Professor, University of Kentucky, Lexington, Kentucky
University of Kentucky
Adam J. Dugan, MS, University of Kentucky Department of Surgery
University of Kentucky
My name is Andrew M. Harris, MD and I'm currently the endourology and robotics fellow at the University of Kentucky. I finished my residency training at the University of Pennsylvania in 2012 followed by a brief period in private practice prior to matriculation to fellowship. My reserach efforts focus on health care economics/cost/safety/qi/lean implementation/resident education and am currently in classes to receive a certificate in improving health care value with an emphasis in safety and quality improvement.