EAU 2018: Debate: Single-Use Flexible Ureteroscopy: Ready to Become Standard?
Dr. Neisius begins the debate by asserting that it is difficult to determine the actual cost of a ureteroscope and many factors (i.e. cost of scope, repairs, processing, delays, etc.) determine the true cost of a re-usable scope. In contrast, current single-use options such as the SemiFlex, Polyscope, Pusen Single-Use Flexible URS, and Lithovue offer similar optic characteristics, maneuverability, and irrigation flow at a much lower cost. Overall, however, if prioritizing quality, Dr. Neisius’ work favors the LithoVue single use scope and concludes that it is a viable alternative to the standard non-disposable 4th generation flexible digital and fiberoptic ureteroscope.
In regards to clinical outcomes, Dr. Neisius maintains a similar stance when considering overall success rates, complication rates, operation time, and radiation exposure time. When 136 patients were randomized to reusable versus single-use URS there were no significant differences between the two arms. Rather, the study obviates issues such as infectious transmissions, fragility, and capital investment.
After brief comment from the moderator, Dr. Doizi enters the debate with a stance against single-use URS. He makes three points in clear opposition: first, single-use flexible URS have a larger diameter when compared to reusable scopes; second, there is a large variation in field of view, resolution / depth of field, and image distortion among the three brands of scopes Dr. Neisius commented about and; third, digital fURS are less effective in accessing sharp angled calix due to less end-tip deflection. In summary, there are high risks of low-quality built fURSs with an increased frequency of breakage with forced maneuvers.
Overall, Dr. Anson and the two panelists agree on the emerging advantages of a single use URS. However, despite recent evaluations in cost and quality, clinical evaluations are still needed to confirm whether these scopes are comparable enough to be adopted as a standard of care. As of current development, though, there still remains a space for reusable URS.
Presented by: A Neisius, MD, Trier, Germany and S Doizi, MD, Paris, France
Moderator: KM Anson, London, Great Britain
Written by: Linda M. Huynh, BS, Department of Urology, University of California-Irvine at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark