ABSTRACT
Objective
To compare the maintenance costs of digital flexible ureteroscopes (DFU) versus fiberoptic
flexible ureteroscopes (FFU) to understand the long-term financial impact associated
with breakage in a flexible ureteroscopy (f-URS) program.
Methods
Data for breakage of FFU and DFU at an academic institution from 2019 to 2021 were
obtained from our vendor (Karl Storz) and analyzed by month. Correlation test was
used to evaluate significant differences in number of procedures, number of breakage
events, breakage rates, and repair cost per month. Cumulative analyses were utilized
to examine the number of procedures before failure (time to failure - TTF) and repair
costs per procedure (RCpP).
Results
We performed a total of 2,154 f-URS, including 1,355 with FFU and 799 with DFU (P<.001). Although we found a higher number of breakage events in FFU (n=124) than DFU
(n=73) (P<.001), the overall breakage rate was similar, 9.9% vs. 8.8%, respectively (P=0.86). On cumulative analysis, both modalities reached the same TTF plateau (11 cases)
after 18 months. After 400 cases, the RCpP for DFU was 1.25 times higher than for
FFU (P=0.04).
Conclusion
Overall, we found no difference in overall scope breakage rates between DFU and FFU.
Although there was no difference in TTF over time, at the beginning DFU displayed
considerable higher durability, leading to lower RCpP. Furthermore, DFU's endurance
leveled off to FFU over time, resulting in higher RCpP after 400 cases. This finding
may be explained by the presence of renewed scopes after repair.
Abbreviations:
DFU (digital flexible ureteroscope), f-URS (flexible ureteroscopy), FFU (fiberoptic flexible ureteroscope), PGY (post-graduate year), RCpP (repair cost per procedure), suFU (single-use flexible ureteroscope), TCpP (total cost per procedure), TTF (time to failure)To read this article in full you will need to make a payment
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References
- Fiber optics in urology.J Urol. 1964; 91: 110-114
- Novel technologies in flexible ureterorenoscopy.Arab J Urol. 2011; 9: 41-46
- Flexible ureteropyeloscopy: diagnosis and treatment in the upper urinary tract.J Urol. 1987; 138: 280-285
- A new world revealed: early experience with digital ureteroscopy.J Urol. 2008; 179: 970-975
- prospective randomized trial comparing 2 flexible digital ureteroscopes: ACMI/olympus invisio DUR-D and olympus URF-V.Urology. 2015; 85: 1267-1271
- Prospective evaluation of refurbished flexible ureteroscope durability seen in a large public tertiary care center with multiple surgeons.Urology. 2014; 84: 42-45
- cost analysis of flexible ureteroscope repairs: evaluation of 655 procedures in a community-based practice.J Endourol. 2016; 30: 254-256
- Outcomes of flexible ureterorenoscopy and laser fragmentation for renal stones: comparison between digital and conventional ureteroscope.Urology. 2013; 82: 1017-1019
- The new digital flexible ureteroscopes: ‘size does matter’–increased ureteric access sheath use!.Urol Int. 2012; 89: 408-411
- Evaluation of overall costs of currently available small flexible ureteroscopes.Urology. 2003; 62: 218-222
- Single-use flexible ureteroscopes: update and perspective in developing countries. A narrative review.Int Braz J Urol. 2022; 48: 456-467
- Epidemiology of stone disease across the world.World J Urol. 2017; 35: 1301-1320
- Comprehensive costs associated with fiberoptic and digital flexible ureteroscopes at a high volume teaching hospital.Urol Pract. 2017; 4: 187-192
- Frequency of ureteroscope damage seen at a tertiary care center.J Urol. 2006; 176 (discussion 10): 607-610
- A comprehensive literature-based equation to compare cost-effectiveness of a flexible ureteroscopy program with single-use versus reusable devices.Int Braz J Urol. 2019; 45: 658-670
- Durability of the next-generation flexible fiberoptic ureteroscopes: a randomized prospective multi-institutional clinical trial.Urology. 2010; 75: 534-538
- The economic implications of a reusable flexible digital ureteroscope: a cost-benefit analysis.J Urol. 2017; 197: 730-735
- Durability of digital flexible ureteroscope in university hospital and ambulatory surgical center: Is It time to rethink?.J Endourol. 2021; 35: 289-295
- Improving flexible ureterorenoscope durability up to 100 procedures.J Endourol. 2012; 26: 1329-1334
- Durability of flexible ureteroscopes: a randomized, prospective study.J Urol. 2006; 176: 137-141
- Is there a difference in outcomes between digital and fiberoptic flexible ureterorenoscopy procedures?.J Endourol. 2010; 24: 1929-1934
- Cost analysis of flexible ureterorenoscopy.BJU Int. 2004; 93: 1023-1026
- Clinical outcomes and costs of reusable and single-use flexible ureterorenoscopes: a prospective cohort study.Urolithiasis. 2018; 46: 587-593
- Decreasing the cost of flexible ureterorenoscopic procedures.Urology. 2011; 78: 528-530
- Conventional fiberoptic flexible ureteroscope versus fourth generation digital flexible ureteroscope: a critical comparison.J Endourol. 2010; 24: 17-21
- Flexible fibre optic vs digital ureteroscopy and enhanced vs unenhanced imaging for diagnosis and treatment of upper tract urothelial carcinoma (UTUC): results from the Clinical Research Office of the Endourology Society (CROES)-UTUC registry.BJU Int. 2021; 128: 734-743
- Influence of pyelocaliceal anatomy on the success of flexible ureteroscopic approach.J Endourol. 2008; 22: 2235-2239
- Techniques to maximize flexible ureteroscope longevity.Urology. 2002; 60: 784-788
- Repair rate and associated costs of reusable flexible ureteroscopes: a systematic review and meta-analysis.Eur Urol Open Sci. 2022; 37: 64-72
Article info
Publication history
Published online: November 15, 2022
Accepted:
October 30,
2022
Received:
July 13,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.