Presentation Authors: Ravi Munver*, Johnson Tsui, Mutahar Ahmed, Gregory Lovallo, Michael Stifelman, Michael Degen, Hackensack, NJ
Introduction: Digital ureteroscopes offer enhanced optics compared to fiberoptic ureteroscopes, however they are also associated with increased repair costs. The selective use of a single-use digital flexible ureteroscope may preserve the life of reusable digital ureteroscopes and reduce the amount of costly repairs. We present our algorithmic approach to implementation of a single-use digital flexible ureteroscope (LithoVueÂ®, Boston Scientific Corporation, Marlborough, MA) and evaluated the impact on scope repair costs.
Methods: An IRB approved retrospective review was performed of all digital flexible ureteroscopy procedures at our institution since January 2016. Our algorithm for using a single-use digital flexible ureteroscope was instituted in 2017, with indications: (1) large stone burden (> 1.5 cm), (2) multiple lower pole stones (> 3), (3) extensive laser use/expected operative duration (> 1 hour), (4) bilateral ureteroscopy, (5) stones within complex/tortuous renal anatomy, and (6) placement of ureteroscope through a trocar or nephroscope sheath. Perioperative data were analyzed, including number of procedures, repairs, and costs.
Results: The total number of ureteroscopy procedures was 418 [272 flexible (65%)] in 2016, 398 [318 flexible (80%)] in 2017, and 403 est. [308 flexible (76%)] in 2018. The total number of ureteroscope repairs was 47 (2016), 35 (2017), and 24 est. (2018). The cost savings was $88,683 (21% decrease) from 2016 to 2017, and $102,229 est. (30% decrease) from 2017 to 2018. The 2-year cost savings from 2016 to 2018 was $190,912 (44%). In 2017, a total of 63 single-use ureteroscopy procedures were performed for single/multiple indications: (1) 35, (2) 9, (3) 14, (4) 5, (5) 6, and (6) 6. In 2018 YTD, a total of 81 single-use ureteroscopy procedures were performed for the indications: (1) 49, (2) 19, (3) 3, (4) 5, (5) 6, and (6) 7. The single-use ureteroscope was used in additional procedures in 2017 (n=26) and 2018 (n=10) to prevent surgery delay or cancellation when a reusable digital ureteroscope was not available, resulting in a positive contribution margin.
Conclusions: Implementation of an algorithm for the LithoVueÂ® resulted in a substantial decrease in reusable digital ureteroscope repair costs comparable to that in 2015, when fiberopic flexible ureterosocpy was exclusively performed at our institution. A single-use ureteroscope spares reusable ureteroscopes from excessive stress and damage, while potentially resulting in cost savings at high volume institutions.