Abstract: PD42-04
Sources of Funding: the NIH NIDDK K12-DK-07-006: Multidisciplinary K12 Urologic Research Career Development Program as well as an educational grant from the Boston Scientific Foundation.

Introduction

While technical advances have improved durability and functionality of reusable flexible ureteroscopes, device use and maintenance can involve high costs and administrative burden. The fragility of these instruments necessitates eventual repair and can render the scope inaccessible during refurbishment. We conducted a multi-institutional prospective cohort study to identify perioperative factors influencing flexible ureteroscope durability.

Methods

This study was a collaboration of the Western Endourology STone (WEST) research consortium consisting of six United States tertiary care centers. Consecutive patients undergoing flexible ureteroscopy were enrolled, and scope performance parameters as well as patient characteristics and intraoperative data were collected between August 2014 and June 2015. Surgeon self-reported concern and satisfaction with each scope were queried following each procedure. Upward and downward angles of deflection of each scope tip were measured before and after procedures. The need for scope repair was determined by the operating surgeon at the time of the procedure and recorded.

Results

386 ureteroscopic procedures using 63 flexible ureteroscopes were identified. 300 cases (77.7%) were performed for stone disease treatment. Scope repair was required in 25 cases (6.5%) and 23 scopes (36.5%). Upon univariate analysis, female gender, shorter patient height, absence of guidewire use, presence of a ureteral access sheath, longer laser time, lithotrite type, surgeon training level, self-reported concern, and degree of scope upward flexion both pre- and postop were associated with need for scope repair. Upon multivariate analysis, access sheath use (OR=3.09, p=0.0127) and decreased degree of upward flexion at the end of the case (OR=0.972, p=0.0171) were associated with need for scope repair (Table 1). Access sheath use, patient height, and surgeon concern were associated with loss of scope upward flexion.

Conclusions

The use of a ureteral access sheath is associated with the loss of upward ureteroscope flexion, which may lead to the need for scope repair. These factors should be considered when evaluating means of optimizing reusable ureteroscope durability.

Funding

the NIH NIDDK K12-DK-07-006: Multidisciplinary K12 Urologic Research Career Development Program as well as an educational grant from the Boston Scientific Foundation.