Economics, Ergonomics, Effectiveness: A Monocentric Comparison of Single-Use vs. Reusable Flexible Ureteroscopes in Challenging Kidney Stone Cases

Abstract

Introduction

Hybrid strategies involving the use of both single-use flexible ureteroscopes (sufURS) and reusable flexible ureteroscopes (rfURS) are being implemented worldwide to extend the longevity of rfURS. We present a retrospective comparison of the clinical performance, ergonomics, and financial aspects between sufURS and rfURS.

Material & Methods

Challenging cases were preoperatively selected based on the presence of nephrolithiasis requiring laser lithotripsy and a steep preoperative infundibulopelvic angle (IPA) < 50°. All procedures were performed at the UKSH Campus Lübeck between January 2020 and March 2021 using sufURS (Pusen PU3022A) and rfURS (Olympus URF-V3). Postoperative surveys to evaluate the performance and ergonomics were completed by the surgeon and the assisting nurse.

Results

A total of 29 sufURS procedures were followed by 25 rfURS procedures. Stone characteristics in both groups were comparable (p > 0.05). No statistically significant differences in clinical outcomes were observed, including stone-free rate, median operation time, or the rate of Clavien-Dindo ≥ 2 complications (p > 0.05). Surgeons found sufURS to be significantly better suited for accessing the lower calyx. Assisting nurses rated sufURS as significantly easier to assemble and dismantle. The overall cost per case was comparable between sufURS (€749) and rfURS (€791).

Conclusions

Both sufURS and rfURS perform comparably for challenging nephrolithiasis cases. sufURS does not offer a clear financial advantage over traditional rfURS.

Zusammenfassung

Einleitung

Hybridstrategien, die die Verwendung sowohl von flexiblen Einweg-Ureterorenoskopen (sufURS) als auch von wiederverwendbaren flexiblen Ureterorenoskopen (rfURS) beinhalten, werden weltweit implementiert, um die Lebensdauer von rfURS zu verlängern. Wir präsentieren einen retrospektiven Vergleich der klinischen Leistung, Ergonomie und finanziellen Aspekte zwischen sufURS und rfURS.

Material & Methoden

Herausfordernde Fälle wurden präoperativ selektiert, als Nephrolithiasis die eine voraussichtliche Laserlithotripsie mit einem steilen präoperativen infundibulopelvinen Winkel (IPA) < 50° erforderten. Alle Eingriffe wurden am UKSH Campus Lübeck zwischen Januar 2020 und März 2021 unter Verwendung von sufURS (Pusen PU3022A) und rfURS (Olympus URF-V3) durchgeführt. Postoperative Umfragen zur Leistung und Ergonomie wurden vom Operateur und der assistierenden Krankenschwester durchgeführt.

Ergebnisse

Insgesamt wurden 29 sufURS-Eingriffe von 25 rfURS-Eingriffen gefolgt. Die Steincharakteristika in beiden Gruppen waren vergleichbar (p > 0.05). Es wurden keine statistisch signifikanten Unterschiede in klinischen Ergebnissen beobachtet, einschließlich Steinfreiheitsrate, mediane Operationszeit oder Rate von Clavien-Dindo ≥2 Komplikationen (p > 0.05). Operateure fanden sufURS signifikant besser geeignet, um den unteren Kelch zu erreichen. Assistierendes Pflegepersonal bewertete sufURS als signifikant einfacher zusammenzubauen und zu demontieren. Die Gesamtkosten pro Fall waren zwischen sufURS (€749) und rfURS (€791) vergleichbar.

Schlussfolgerungen

Sowohl sufURS als auch rfURS sind bei herausfordernden Nephrolithiasis-Fällen vergleichbar. sufURS bietet keinen klaren finanziellen Vorteil gegenüber traditionellen rfURS.

Keywords

single-use - ergonomics - cost analysis - flexible ureteroscopy - reusable

Schlüsselwörter

single-use - Ergonomie - Kostenanalyse - flexible Ureterorenoskopie

Publikationsverlauf

Eingereicht: 13. April 2024

Angenommen nach Revision: 04. Juni 2025

Artikel online veröffentlicht:
06. August 2025

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