Durability of Flexible Ureteroscopes: A Prospective Evaluation of Longevity, the Factors that Affect it, and Damage Mechanisms.
BACKGROUND
Flexible ureteroscopy is an established treatment modality for evaluating and treating abnormalities in the upper urinary tract. Reusable ureteroscope (USC) durability is a significant concern.


OBJECTIVE
To evaluate the durability of the latest generation of digital and fiber optic reusable flexible USCs and the factors affecting it.


DESIGN, SETTING, PARTICIPANTS
Six new flexible USCs from Olympus and Karl Storz were included. The primary endpoint for each USC was its first repair. Data on patient and treatment characteristics, accessory device use, ureteroscopy time, image quality, USC handling, disinfection cycles, type of damage, and deflection loss were collected prospectively.


INTERVENTION
Ureteroscopy.


OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
USC durability was measured as the total number of uses and ureteroscopy time before repair. USC handling and image quality were scored. After every procedure, maximal ventral and dorsal USC deflection were documented on digital images.


RESULTS AND LIMITATIONS
A total of 198 procedures were performed. The median number of procedures was 27 (IQR 16-48; 14h) for the six USCs overall, 27 (IQR 20-56; 14h) for the digital USCs, and 24 (range 10-37; 14h) for the fiber optic USCs. Image quality remained high throughout the study for all six USCs. USC handling and the range of deflection remained good under incremental use. Damage to the distal part of the shaft and shaft coating was the most frequent reason for repair, and was related to intraoperative manual forcing. A limitation of this study is its single-center design.


CONCLUSIONS
The durability of the latest reusable flexible USCs in the current study was limited to 27 uses (14h). Damage to the flexible shaft was the most important limitation to the durability of the USCs evaluated. Prevention of intraoperative manual forcing of flexible USCs maximizes their overall durability.


PATIENT SUMMARY
Current flexible ureteroscopes proved to be durable. Shaft vulnerability was the most important limiting factor affecting durability.
['Legemate|Jaap D|JD|', 'Kamphuis|Guido M|GM|', 'Freund|Jan Erik|JE|', 'Baard|Joyce|J|', 'Zanetti|Stefano P|SP|', 'Catellani|Michele|M|', 'Oussoren|Harry W|HW|', 'de la Rosette|Jean J|JJ|']
D019719:Diagnostic Equipment D017743:Equipment Reuse D005260:Female D005336:Fiber Optic Technology D006801:Humans D008136:Longevity D008297:Male D011446:Prospective Studies D020709:Ureteroscopes D018666:Ureteroscopy D014551:Urinary Tract
Durability Ureteroscope Ureteroscopy Equipment reuse Kidney Ureter