San Diego, CA USA (UroToday.com) Use of a guide wire greatly facilitates retrograde endourologic access to the renal pelvis and upper ureter. However, with the recent development of newer hybrid guide wires that combine the advantages of several different types, it is unclear as to what type of guide wire should be standard of care.
The authors hypothesized that it would not be cost-effective to routinely employ a hybrid guide wire that combines a hydrophilic tip with a polytetrafluoroethylene (PFTE)-coated shaft over a nitinol core over a standard 0.038-inch stainless steel fixed core PFTE-coated wire with a 5cm flexible tip. The authors attempted to use the standard wire in all cases and used the hybrid guide wire as a backup. Cost of the standard wire was $11, while cost of the hybrid wire was $52.
300 cases were recorded, with the majority being for ureteral or renal stones. Initial wire placement was possible with the standard wire in 64% of cases; in the 36% of cases where it was unsuccessful, the hybrid wire was a successful second-line in 60% of cases. The standard wire was successful in 93% of cases without active ureteral pathology and 61.8% of cases with active ureteral pathology. With this case volume, use of the standard wire was associated with a cost savings of $7,831 over six months.
Although the hybrid guide wire has numerous advantages and may be easier for a surgeon to use, it is associated with a much higher cost and may not be necessary in up to 2/3 of cases, especially those without active ureteral pathology. The authors suggest that an inexpensive wire should be the first line choice in uncomplicated cases, while the hybrid wire is reserved as a back up in case access becomes difficult.
Presented By: Scott Hubosky, MD
Written By: Rahul Dutta, BS; Urology Fellow, Department of Urology, University of California, Irvine at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA