Separately, investigators from the University of Melbourne and Austin Hospital in Australia focused their analysis on ex vivo performance and cost-effectiveness of the LithoVue ureteroscope. They performed an analysis of reusable flexible ureteroscope damage with two commonly used instruments—the Olympus URF-V and the Storz Flex-Xc—at their institution over 30 months, assuming an initial purchase cost of $26,372 Australian and fixed cleaning costs of $26.23 per case. Repair costs were averaged as if happening to a single scope.
They found 15 instances of major ureteroscope damage with 234 cases performed over the 30 months. (Damage was considered major when the cost exceeded $10,000 Australian.) The mean number of cases performed before damage was 15.6. The total cost of repairs was $162,628 Australian. Including purchase price and repair costs, mean cost per case was $695 Australian.
“After 28 cases, the cost of using and maintaining a reusable flexible ureteroscope was approximately $50,000 (Australian); that’s about $34,000 U.S. dollars,” said lead investigator Damien Bolton, MD, head of surgery at Austin Hospital, Heidelberg, Victoria, Australia. If the price of the single-use ureteroscope is $1,200 Australian or less, it will be more economical than reusable flexible ureteroscopes, whereas it would not be economical if the price exceeded $2,500 Australian.
“I don’t know if this will be the ureteroscope for every stone case at every institution, but where you have stone cases where you are at high risk of damaging your valuable reusable scope, this clearly has a role,” he told Urology Times.
“The cases that caused major damage tended to be staghorn stones or partial stags, or stones in lower pole calyses, so I would recommend to consider that if you have a patient in whom you feel that you’re going to damage your very expensive reusable scope, you might use a single-use scope instead if it’s going to cost you less than $2,000,” said co-author Derek Hennessy, MD, clinical fellow at Austin Hospital.
With an empty working channel, range of movement was superior with the single-use instrument. Flexion of the single-use scope is 285° compared with 180° with the URF-V and 283° with the Flex-Xc. Deflection was 286°, 270°, and 219° for LithoVue, URF-V, and Flex-Xc, respectively. At 100 cm, irrigation flow with the single-use ureteroscope was superior to that of the reusable scopes. This superiority was maintained with a 200-µm Holmium laser fiber and a 1.9F stone basket in the channel.
The single-use scope displayed satisfactory ergonomics, maneuverability, and image quality in the treatment of renal stones in three patients. Complete stone fragmentation and clearance was achieved in all cases.
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