Clinical Scorecard: Economic Comparison of Reusable and Disposable Ureteroscopes in Advanced Renal Surgical Procedures: A Randomized Cohort Analysis

At a Glance

Key Highlights

• ECIRS integrates percutaneous nephrolithotomy with flexible retrograde ureteroscopy for complex stone management, reducing tract creation.
• Single-use ureteroscopes provide comparable stone-free rates, maneuverability, and visibility to reusable scopes in RIRS and ECIRS contexts.
• Cost-benefit analysis conducted comparing latest generation reusable digital scopes (URF-V3) and single-use scopes (WiScope®, Uscope®) in ECIRS.

Guideline-Based Recommendations

Diagnosis

• Use CT scan at 3 months postoperatively to assess stone-free status, categorized by remnant size (Grade A-D).

Management

• Perform ECIRS under general anesthesia with patient positioning per surgeon discretion (modified Galdakao–Valdivia or prone split-leg).
• Use ureteral access sheath and flexible ureteroscope with automated irrigation at 90 mmHg pressure.
• Induce artificial hydronephrosis via retrograde contrast injection.
• Fragment stones using LithoClast lithotripsy or Ho:YAG laser through mini-nephroscope and flexible URS.
• Place 6-Fr double-J ureteric stent post-procedure; nephrostomy tube if active bleeding occurs.

Monitoring & Follow-up

• Document intraoperative parameters including surgical duration, laser use, and fluoroscopy time.
• Monitor perioperative and postoperative complications, bacteriuria, infection, and stone-free status.

Risks

• Reusable ureteroscopes have increased risk of damage and breakage during aggressive ECIRS use, leading to repair costs.
• Single-use scopes may have longer surgical durations and higher rates of preoperative positive urine cultures.

Patient & Prescribing Data

Patients undergoing ECIRS for renal/ureteral stones >15 mm, excluding pregnancy, uncontrolled diabetes, solitary kidneys, urinary anomalies, or urethral strictures.

Randomized allocation to reusable URF-V3 or single-use 7.5Fr flexible ureteroscopes showed comparable surgical outcomes; reusable scopes require repairs after multiple uses, influencing cost-effectiveness.

Clinical Best Practices

• Randomize patients considering age, sex, stone burden, and stone location to optimize comparative analysis.
• Use ultrasound-guided renal puncture with direct vision from flexible URS when feasible.
• Apply automated irrigation systems to maintain consistent intrarenal pressure during ureteroscopy.
• Record detailed intraoperative and postoperative data to assess scope durability and surgical outcomes.
• Consider repair frequency and costs when selecting reusable ureteroscopes for ECIRS.

References

• UMIN Clinical Trials Registry - Study Registration
• EZR Statistical Software