Presentation Authors: José Salvadó*, Rodrigo Sanchez, José Cabello, Renato Cabello, Sergio Moreno, Álvaro Kompatzki, Ruben Olivares, Alfredo Velasco, Santiago, Chile
Introduction: The best option in management of the lower pole stones is still a matter of debate. Retrograde intrarenal surgery is one of the less invasive alternatives accepted today. With the recent incorporation of disposable flexible ureteroscopes, the discussion on this topic has been reactivated. The aim of this study was to compare the clinical results between flexible disposable and reusable ureteroscopes, in lower pole stones treatment.
Methods: A case and control study was carried out using data registered prospectively in a database from our center. The clinical results from 2 groups of patients were analyzed. In the first group of patients, surgery was performed with a reusable flexible fiberoptic ureteroscope (CobraÂ®, Richard Wolf) and for second group, a disposable flexible ureteroscope was used (Uscope 3022Â®, Pusen Medical). All procedures were performed with nitinol baskets, holmium laser lithotripsy and ureteral access sheaths whenever needed. The variables analyzed included: total surgery time, fluoroscopy time, post-procedure ureteral catheter requirement, stone free rate and complications(Clavienâ€“Dindo) among others. The results were evaluated using Student's t test, Mann-Whitney test and Fisher's test.
Results: 30 cases were performed with reusable ureteroscope and 31 cases with single - use ureteroscope. Both groups were comparable in their demographic and clinical variables including stone burden, number of pre-stenting patients and use of access sheath. The characteristics regarding length, width and angle of the infundibulum (measured by retrograde ureteropyelography) were also comparable. Regarding the clinical results, there were no difference with respect to stone free rate, need for ureteral catheter, complications or hospital stay. Significant differences were found for the average surgery time, 56.1 vs 77 mins (p = 0.01), as well as with respect to the fluoroscopy time 66.1 vs 83.4 sec (p = 0.02), both in favor of disposable ureteroscopes.
Conclusions: Disposable flexible ureteroscopes have been validated as an option, at least equivalent, with respect to reusable ones when evaluating clinical results in the treatment of lower pole stones. The shorter duration of the surgery and less fluoroscopy during the procedure could play in its favor, especially considering the high costs associated with the operating room use, as well as the need to reduce radiation exposure.