Category: Clinical Stones: Ureteroscopy

MP29-14 - Risk Factors for Flexible Ureteroscope (fURS) Damage. Retrospective Monocentric Multifactorial Analysis.

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

Introduction & Objective : The increasing number of flexible ureteroscopy (fURS) procedures, the fragility of devices and their growing repair costs represent a substantial burden for urological departments worldwide. Objective was to investigate the impact of 26 pre- and intraoperative factors on reusable fURS damage.


Methods : All procedures were conducted with modern reusable fURS: Karl Storz Flex-X2 or Olympus URF-V. Infundibulopelvic Angle (IPA) was measured based on intraoperative retrograde pyelography images. Statistical analysis was performed in RStudio (1.0.136) with Chi2 test, unpaired t-test and Mann-Whitney U-Test.


Results : In total, 416 flexible ureteroscopies performed between September 2013 and June 2017 were analyzed: 283 (68.03%) for kidney stone surgery, and 133 (31.97%) for diagnostic purposes; of these 39 (9.38%) devices were postoperatively deemed defective. 
IPA was steeper in cases with fURS damage compared to cases without damage (Median 44.0 degrees [Min 20.0; Max 81.0] vs. 55.0 [Min 7.0; Max 122.0], p<0.001).  The application of laser fiber through fURS was more common in cases with documented defect (17/39 [43.59%] vs. 102/377 [27.06%], p=0.047). Moreover, fURS defects impaired postoperative stone free rate (14/29 [48.28%] vs. 191/254 [75.20%], p=0.004). Other factors such as total laser energy, operation time, number of kidney stones, maximal stone diameter, access sheath application, stone extraction with nitinol basket or biopsy performed with fURS showed no significant influence on fURS damage rate (p>0.05). 


Conclusions : Application of laser fiber through fURS as well as steep IPA can be considered as risk factors of fURS damage. Special intraoperative attention is advised to avoid future repairs of reusable fURS. A better understanding of damage mechanisms is the key for the indication to use costly disposable fURS.

Tomasz Ozimek

University Hospital Schleswig-Holstein (Campus Luebeck)
Luebeck, Schleswig-Holstein, Germany

Jens Cordes

University Hospital Schleswig-Holstein (Campus Luebeck)
Luebeck, Schleswig-Holstein, Germany

Nils Gilbert

University Hospital Schleswig-Holstein (Campus Luebeck)
Luebeck, Schleswig-Holstein, Germany

Marie C. Hupe

University Hospital Schleswig-Holstein (Campus Luebeck)
Luebeck, Schleswig-Holstein, Germany

Judith R. Wiessmeyer

Fellow
University Hospital Schleswig-Holstein (Campus Luebeck)
Luebeck, Schleswig-Holstein, Germany

Michael H. Schneider

University Hospital Schleswig-Holstein (Campus Luebeck)
Luebeck, Schleswig-Holstein, Germany

Axel S. Merseburger

University Hospital Schleswig-Holstein (Campus Luebeck)
Luebeck, Schleswig-Holstein, Germany

Mario W. Kramer

University Hospital Schleswig-Holstein (Campus Luebeck)
Luebeck, Schleswig-Holstein, Germany