AUA 2018: Bad Out of the Box: A Report on Pre-Operative Failure Rates of Reusable Flexible Ureteroscopes at a Single Institution

San Francisco, CA USA ( Brian Calio, a medical student from Thomas Jefferson University Hospital presented his data on the pre-operative failure rates of flexible ureteroscopes. Single-use flexible digitable ureteroscopes come with many advantages including high image quality and flawless functionality. However, existing financial models have put forth a cost-benefit analysis which takes into account the original purchase costs, repair fees, and reprocessing charges for reusable ureteroscopes. Mr. Calio and his team sought to define the rate of encountering a reusable flexible ureteroscope which is unsuitable for immediate use in a consecutive group of patients undergoing flexible ureteroscopy for various indications.

Mr. Calio and his team performed a prospective analysis of 228 consecutive cases of flexible ureteroscopy over a time period of 6 months. The research team primarily recorded the number of ureteroscopes needed to be unpackaged in order to initiate the case, in addition to problems encountered with ureteroscopes upon opening the sterile package. The following criteria were used to assess which ureteroscopes were acceptable for clinical usage: reasonable visualization, reasonable bidirectional deflection, working channel able to accept instruments/laser fibers, no gross contamination, no over-structural damage or deformity to ureteroscope components, and no violation of sterile packaging.

The results of this study revealed that a total of 261 ureteroscopes out of 228 cases were unwrapped and 207 (91.0%) of cases were initiated with the first instrument open. In 21 (9.2%) of the cases, two ureteroscopes needed to be opened in order to initiate the case. One case needed to be rescheduled after 4 consecutive instruments were opened and all were unsuitable for case initiation. In total, 33 (12.6%) ureteroscopes of the 261 opened were unsuitable for immediate use.

In conclusion, the results of this study indicate that etiologies for problems with single-use ureteroscopes include processing errors as well as delay in sending ureteroscopes out for repair. In addition to case inefficiency, these instrument problems pose potential patient safety issues if not proactively identified prior to instrument use. This represents an immediate area for improvement with single-use instrument utilization.
After his presentation, Mr. Calio was asked if his team broke down why the problematic uteroscopes were unusable, to which he responded that the two primary causes were broken deflection and remnants of cleaning solution found on the scope upon opening the packages.

Presented by: Brian Calio

Written by: Taylor Capretz, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA