Editor’s note: This is an edited version of a previously published blog post. It has been updated for clarity and style.
First, full disclosure is in order: I, along with other local urologists, attended an industry dinner sponsored by the maker of the product discussed in this blog post. I will leave it to readers to decide whether that changes either my opinion of the device the company was promoting or the lessons I took from the dinner.
The product is a single-use ureteroscope. Such scopes are not new. I saw a Chinese-made one some years ago that looked nothing like a ureteroscope, so I ignored it. At that point I was perfectly happy with my reusable fiber optic scope, so I wasn’t even thinking about a disposable scope. Over the last few years, though, I have been following the data on contamination of various scopes with superbugs (think carbapenem-resistant Enterobacteriaceae [CBE]-infected duodenoscopes) and have been wondering if I would need to change either my in-office flexible cystoscopes or my ureteroscopes as a result.
So when I learned about a new single-use ureteroscope from Boston Scientific after seeing it at the 2017 AUA meeting, I was intrigued. Further, when the company’s roadshow came to Colorado Springs, and since I had nothing else to do that evening, I took the offer. It didn’t hurt that I knew the doctor giving the talk (Thomas Chi, MD, from UCSF) and knew he was a smart and honest guy whose previous research I had read and respected.
But let’s be honest, this is not the first industry dinner I’ve attended and by no means is my intent to give a company free advertising. That said, I learned a very valuable lesson from this dinner and thought the lesson would be worth sharing.
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First, though, a little about the toy itself. The scope looks and feels like a ureteroscope and, while I have never used a single-use scope myself, I have spoken with enough doctors who have used one to feel comfortable saying that it works perfectly fine. It may not have the fanciest digital chip on the market, so if you are expecting super high-end optics, that’s not going to happen. But borrowing a phrase from Dr. Chi, “It’s in the ballpark.” For the vast majority of the work we do, that is fine. Perhaps if you are looking for a small upper tract transitional cell carcinoma, then using a nice digital scope is appropriate, but for the standard proximal ureteral stone, this scope is more than adequate.
Second, there is now published data questioning our ability to truly clean flexible ureteroscopes. Ofstead et al examined 16 reusable flexible ureteroscopes after undergoing standard sterilization and found that every scope had “visible irregularities, such as discoloration, residual fluid, foamy white residue, scratches, or debris in channels.” They also found evidence of contamination on every scope (microbial growth in 13%, adenosine triphosphate in 44%, hemoglobin in 63%, and protein in 100%).
The clinical significance of this certainly remains debatable given the low published rate of infection secondary to ureteroscopic procedures, but if bacteria such as CBE become more common in our patients, it may change our calculations. It also raises the question of whether single-use equivalent flexible cystoscopes (using a disposable sheath) should be standard of care, but the evidence for that is also minimal at best.