Login to Access Video or Poster Abstract: MP50-07
Sources of Funding: None

Introduction

The new single use digital flexible ureteroscope (fURS), LithoVue is an evolution in digital ureteroscope design. We aimed to assess the capability of this instrument in-vivo and in-vitro, and to compare it to commonly used flexible ureteroscopes in regard to these metrics and also its cost effectiveness

Methods

An analysis of standard flexible ureteroscope (Olympus URF-V) usage at our institution over 30 months was performed for a cost analysis of fURS practice. The LithoVue was then examined in-vitro for manoeuvrability and flow and compared to Olympus URF-V and Stortz Flex Xc. Finally, LithoVue was used in 3 patients for the treatment of renal calculi. The single-use ureteroscope (Lithovue®, Boston Scientific) and two reusable scopes (URV-F®, Olympus and Flex-Xc®, Karl Storz) were assessed. Angulation and irrigation fluid flow were examined first with an empty working channel and than with various instruments engaged: _x000D_ - hydrophilic guide wire _x000D_ - hydrophilic tip wire _x000D_ - laser fiber (200µm)_x000D_ - basket (1.9Fr) _x000D_ - biopsy forceps (3Fr)_x000D_

Results

With regard to cost analysis 265 fURS procedures were performed over the study period. 20 instances of ureteroscope damage occurred – classed as 15 major and 5 minor. Total cost of repairs was $162,587 AUD. Including purchase price and repair costs, mean cost per fURS case was $1883 AUD. In regard to performance metrics, with an empty working channel the Lithuvue was superior to both the URF-V and Flex Xc in terms of movement. Flexion of the Lithovue is 285°, while the URF-V is 180° and the Flex Xc is 283°. Deflection for the Lithovue is 286°, the URF-V is 270° and the Flex Xc 219°. Superiority of the Lithovue over the two other ureteroscopes was maintained for movement in both directions with a variety of instruments placed within the working channel. Finally, the LithoVue was demonstrated to display satisfactory ergonomics, manoeuvrability and image quality in the treatment of renal stones in 3 patientsInstruments decreased the angulation range and fluid flow. However it was still possible to bend tested devices to almost 180 degrees in every case, which should be enough to reach all kidney calyxes. Furthermore there were only slight differences in fluid flow in used scopes

Conclusions

This version of a single use disposable flexible ureteroscope offers similar technical specifics to multiple use flexible ureteroscopes in regard to range of flexion and extension, and also in regard to fluid flow rates. It is likely to find utility in aspects of endourologic practice depending upon pricing issues. Based on purchase costs and rate of repair it may also represent a cost saving for hospitals in regard to an amortised cost per case for this procedure.

Funding

None