Economic Comparison of Reusable vs Disposable Ureteroscopes in ECIRS
Overview
This randomized cohort study compared the cost-effectiveness and clinical outcomes of reusable digital ureteroscopes (URF-V3) versus single-use flexible ureteroscopes (WiScope® and Uscope®) in endoscopic combined intrarenal surgery (ECIRS). Despite longer surgical times and higher preoperative infection rates in the single-use group, clinical outcomes including stone-free rates and complications were similar. The study also analyzed scope durability and repair costs to assess economic implications.
Background
Urolithiasis prevalence has risen globally, increasing the demand for advanced endoscopic procedures like ECIRS, which combines percutaneous nephrolithotomy and flexible ureteroscopy for complex stone management. ECIRS's aggressive use of ureteroscopes raises the risk of scope damage, prompting development of single-use ureteroscopes to mitigate repair costs. Prior meta-analyses in retrograde intrarenal surgery (RIRS) showed no significant performance differences between reusable and disposable scopes, suggesting cost and logistics as key factors in scope selection. This study evaluates these factors specifically in the ECIRS context.
Data Highlights
Parameter
Reusable URS (URF-V3)
Single-use URS (WiScope®/Uscope®)
Number of patients
89
89
Preoperative positive urine culture
Lower
Significantly higher
Ureteroscopic-assisted puncture
Lower
Significantly higher
Surgical duration
Shorter
Longer
Stone-free rates
Comparable
Comparable
Perioperative complications
Comparable
Comparable
Scope repairs per URF-V3
At least one repair per scope
Not applicable
Key Findings
No significant differences in stone-free rates or perioperative complications between reusable and single-use ureteroscope groups.
Single-use URS group had higher rates of preoperative positive urine cultures and ureteroscopic-assisted punctures.
Surgical duration was longer in the single-use URS group compared to the reusable URS group.
Each reusable URF-V3 scope required at least one repair due to breakage during ECIRS.
Cost analysis incorporated repair frequency and decreasing scope durability after repairs to estimate break-even points.
Clinical Implications
Clinicians can consider both reusable and single-use ureteroscopes as viable options for ECIRS without compromising clinical outcomes. However, the choice may be influenced by institutional factors such as scope repair costs, availability, and surgical duration. Understanding scope durability and repair expenses is essential for cost-effective resource allocation in advanced renal stone surgery.
Conclusion
This study demonstrates comparable clinical efficacy between reusable and single-use ureteroscopes in ECIRS, with economic considerations hinging on scope durability and repair costs. These findings support individualized decision-making based on logistical and financial factors rather than performance differences alone.
References
Nagoya City University Hospital Study 2021-2024 -- Economic Comparison of Reusable and Disposable Ureteroscopes in ECIRS
