Maintenance of flexible ureteroscopes can involve high costs and administrative burden. Instrument fragility necessitates eventual repair, rendering scopes inaccessible during refurbishment. We conducted a multi-institutional prospective cohort study to identify perioperative factors influencing flexible ureteroscope durability. Patients undergoing flexible ureteroscopy (URS) at six United States endourology centers were enrolled between August 2014 and June 2015. Surgeon self-reported concern and satisfaction with scope performance as well as upward and downward angles of deflection for each scope tip were measured before and after each procedure. The need for scope repair was determined by the operating surgeon at the time of the procedure and recorded. 424 URS cases using 74 flexible ureteroscopes were identified. Scope repair was required in 28 cases (6.6%) involving 26 scopes (35.1%). Upon univariate analysis, shorter patient height, absence of guidewire use, presence of a ureteral access sheath (UAS), longer procedure time, larger stone size, lithotrite type, surgeon training level, and self-reported concern were associated with scope repair. Upon multivariate analysis, UAS use (OR = 2.53, p = 0.005) and degree loss of scope upward flexion during a case (OR = 1.02, p = 0.03) increased the odds of a scope needing repair while the use of safety guidewire decreased the odds of a scope repair (OR = 0.50, p = 0.045). Lithotrite use and surgeon concern were associated with degree loss of scope upward flexion. The use of a UAS, absence of a safety guidewire, and the loss of upward ureteroscope flexion should be considered when evaluating means of optimizing reusable ureteroscope durability.
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This work was supported by the educational grant from the Boston Scientific Foundation (TC), the US National Institutes of Health with grants K12-DK-07-006 (TC), and P20-DK-100863 (MLS, TC). This material is also the result of work supported by resources from the Veterans Affairs Puget Sound Health Care System, Seattle, Washington. The sponsors played no direct role in the study.
Compliance with ethical standards
This study was funded by the educational grant from the Boston Scientific Foundation, the US National Institutes of Health with grants K12-DK-07-006, and P20-DK-100863.
Conflict of interest
Marshall L. Stoller and Thomas Chi serve as paid speakers and consultants for Boston Scientific Corporation and have received educational grant funding from Richard Wolf. Marshall L. Stoller has served as a paid speaker for the Karl Storz Company.
All procedures performed in studies involving human participants were in accordance with the ethical standards of each institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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