Objective: Single-use flexible ureteroscopes (fURSs) have recently been introduced by different companies. Goal of this in-vitro study was to compare four fURSs.
Methods: We performed in vitro analysis of Uscope 7.5 Fr and Uscope 9.5 Fr (Pusen Ltd., Zhuhai, China), LithoVue 9.5 Fr (LithoVue?, Boston Scientific, MA, USA), and Indoscope 9.5 Fr (Bioradmedisys?, Pune, India). Optical characteristics (image resolution, color representation, and luminosity) were compared at various distances of 10 mm, 20 mm, and 50 mm. Deflection and irrigation were evaluated with and without accessories.
Results: Color perception was comparable for all scopes at 10 mm (p<0.05), while Lithovue 9.5 Fr was comparable with Indoscope 9.5 Fr at the distances of 20 mm and 50 mm. Both scopes were statistically better than both Uscopes at the distances of 20 mm and 50 mm. Image resolution powers were comparable amongst all fURSs at the distances of 10 mm and 20 mm (3.56 line pairs per millimeter [lp/mm]). However, Indoscope (3.56 lp/mm) was superior to LithoVue and Uscope scopes (3.17 lp/mm) at the distance of 50 mm. Luminosity at the distance of 10 mm was comparable for LithoVue and Uscope 9.5 Fr. However, at the distances of 20 mm and 50 mm, LithoVue had the highest luminosity while Uscope 7.5 Fr had the lowest one. Indoscope had lower luminosity than other 9.5 Fr scopes at all distances. With empty working channel and 200 μm laser fiber, Indoscope had the maximum deflection (285°). With basket, Uscope 7.5 Fr had the maximum loss of deflection (30°) while Indoscope had no deflection loss. With empty working channel, all scopes had comparable irrigation flow rates in both deflected and undeflected state. Similarly, with 200 μm laser or basket, irrigation flow rates were comparable in all scopes.
Conclusion: Color representation was equivalent for Indoscope and LithoVue, while being better than Uscope 7.5 Fr and Uscope 9.5 Fr. Image resolution was comparable in all scopes at the distances of 10 mm and 20 mm. Beyond the distance of 10 mm, luminosity of LithoVue was the highest and that of Uscope 7.5 Fr was the lowest. Deflection loss was the minimum with Indoscope and the maximum with 7.5 Fr Uscope. Under all scenarios, irrigation flow rates were comparable in all scopes.
. [J]. Asian Journal of Urology, 2023, 10(1): 64-69.
Abhijit Patil,Shashank Agrawal,Rohan Batra,Abhishek Singh,Arvind Ganpule,Ravindra Sabnis,Mahesh Desai. Single-use flexible ureteroscopes: Comparative in vitro analysis of four scopes. Asian Journal of Urology, 2023, 10(1): 64-69.
Endoscopic exit point (working channel tip position)
3 o'clock
3 o'clock
3 o'clock
9 o'clock
Deflection type
Dual deflection
Dual deflection
Dual deflection
Dual deflection
[1]
Rukin NJ, Siddiqui ZA, Chedgy EC, Somani BK.Trends in upper tract stone disease in England: evidence from the hospital episodes statistics database. Urol Int 2017; 98:391e6.
[2]
Saigal CS, Joyce G, Timilsina AR; Urologic Diseases in America Project. Direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management?Kidney Int 2005; 68:1808e14.
[3]
Koyuncu H, Yencilek F, Kalkan M, Bastug Y, Yencilek E, Ozdemir AT. Intrarenal surgery vs. percutaneous neph-rolithotomy in the management of lower pole stones greater than 2 cm. Int Braz J Urol 2015; 41:245e51.
doi: 10.1590/S1677-5538.IBJU.2015.02.09
pmid: 26005965
[4]
Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical management of stones: American urological Association/Endourological Society guideline, PART I. J Urol 2016; 196:1153e60.
doi: 10.1016/j.juro.2016.05.090
pmid: 27238616
[5]
Proietti S, Dragos L, Molina W, Doizi S, Giusti G, Traxer O. Comparison of new single-use digital flexible ureteroscope versus nondisposable ?ber optic and digital ureteroscope in a cadaveric model. J Endourol 2016; 30:655e9.
doi: 10.1089/end.2016.0051
pmid: 27084572
[6]
Usawachintachit M, Isaacson DS, Taguchi K, Tzou DT, Hsi RS, Sherer BA, et al. A prospective case-control study comparing LithoVue, a single-use, flexible disposable ureteroscope, with flexible, reusable ?ber-optic ureteroscopes. J Endourol 2017; 31:468e75.
doi: 10.1089/end.2017.0027
pmid: 28287823
[7]
Winship B, Wollin D, Carlos E, Li J, Preminger GM, Lipkin ME. Avoiding a lemon: performance consistency of single-use ureteroscopes. J Endourol 2019; 33:127e31.
doi: 10.1089/end.2018.0805
pmid: 30612445
[8]
Salvadó JA, Olivares R, Cabello JM, Cabello R, Moreno S, Pfeifer J, et al. Retrograde intrarenal surgery using the single-use flexible ureteroscope Uscope 3022 (PusenTM): evaluation of clinical results. Cent Eur J Urol. 2018;71: 202e7.
[9]
Marchini GS, Batagello CA, Monga M, Torricelli FCM, Vicentini FC, Danilovic A, et al. In vitro evaluation of single-use digital flexible ureteroscopes: a practical comparison for a patient-centered approach. J Endourol 2018; 32:184e91.
doi: 10.1089/end.2017.0785
pmid: 29239229
[10]
Emiliani E, Mercadé A, Millan F, Sánchez-MartínF, Konstantinidis CA, Angerri O. First clinical evaluation of the new single-use flexible and semirigid Pusen ureteroscopes. Cent Eur J Urol 2018;71:208e13.
[11]
Kam J, Yuminaga Y, Beattie K, Ling KY, Arianayagam M, Canagasingham B, et al. Single use versus reusable digital flexible ureteroscopes: a prospective comparative study. Int J Urol 2019; 26:999e1005.
doi: 10.1111/iju.14091
pmid: 31448473
[12]
Rajamahanty S, Grasso M. Flexible ureteroscopy update: in-dications, instrumentation and technical advances. Indian J Urol 2008; 24:532e7.
doi: 10.4103/0970-1591.44263
[13]
De La Rosette J, Denstedt J, Geavlete P, Keeley F, Matsuda T, Pearle M, et al. The clinical research of?ce of the endouro-logical society ureteroscopy global study: indications, com-plications, and outcomes in 11 885 patients. J Endourol 2014; 28:131e9.
doi: 10.1089/end.2013.0436
pmid: 24147820
[14]
Bagley DH, Huffman JL, Lyon ES. Flexible ureteropyeloscopy: diagnosis and treatment in the upper urinary tract. J Urol 1987; 138:280e5.
doi: 10.1016/s0022-5347(17)43119-3
pmid: 3599238
[15]
Proietti S, Somani B, Sofer M, Pietropaolo A, Rosso M, Saitta G, et al. The “body mass index” of flexible ureteroscopes. J Endourol 2017; 31:1090e5.
doi: 10.1089/end.2017.0438
pmid: 28835120
[16]
Somani BK, Al-Qahtani SM, Traxer O. Out-comes of flexible ureterorenoscopy and laser fragmentation for renal stones: comparison between digital and conventional ureteroscope. Urology 2013; 82:1017e9.
doi: 10.1016/j.urology.2013.07.017
[17]
Dragos LB, Somani BK, Keller EX, De Coninck VM, Herrero MR-M, Kamphuis GM, et al. Characteristics of current digital single-use flexible ureteroscopes versus their reusable counterparts: an in vitro comparative analysis. Transl Androl Urol 2019 ;8(Suppl 4):S359e70. https://doi.org/10.21037/tau.2019.09.17.
[18]
Audenet F, Traxer O, Yates DR, Cussenot O, RouprêtM. Po-tential role of photodynamic techniques combined with new generation flexible ureterorenoscopes and molecular markers for the management of urothelial carcinoma of the upper urinary tract. BJU Int 2012; 109:608e13.
doi: 10.1111/j.1464-410X.2011.10363.x
[19]
Mandalapu RS, Remzi M, de Reijke TM, Margulis V, Palou J, Kapoor A, et al. Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of low-risk upper tract urothelial carcinoma. World J Urol 2017; 35: 355e65.
doi: 10.1007/s00345-016-1859-6
pmid: 27233780
[20]
Shah HN. Retrograde intrarenal surgery for lower pole renal calculi smaller than one centimeter. Indian J Urol 2008; 24: 544e50.
doi: 10.4103/0970-1591.44265
[21]
Dale J, Kaplan AG, Radvak D, Shin R, Ackerman A, Chen T, et al. Evaluation of a novel single-use flexible ureteroscope. J Endourol 2017; 35:903e7.
doi: 10.1089/end.2016.0237
[22]
Bach C, Nesar S, Kumar P, Goyal A, Kachrilas S, Papatsoris A, et al. The new digital flexible ureteroscopes: "size does mat-ter"dincreased ureteric access sheath use. Urol Int 2012; 89: 408e11.
doi: 10.1159/000341429
pmid: 22964494
[23]
From internet, https://bioradmedisys.com/medical-devices/urologydisposableproducts/13991-2/. [Accessed 23 June 2020].
