WCE 2017: Defining the Rate of Encountering Unacceptable Reusable Flexible Ureteroscopes for Immediate Clinical Use: 'Bad out of the Box'

Vancouver, Canada (UroToday.com) Hubosky et al. present a prospective study of 103 consecutive cases in which a total of 119 reusable flexible ureteroscopes (fURS) were unwrapped. Their inventory consisted of four digital and 18 fiberoptic reusable fURS. Ninety-three cases (90%) were initiated with the first opened reusable fURS. A fURS was defined as acceptable if it provided adequate visualization, deflection, and a functional working channel with no evidence of contamination, damage, or deformity.  
The first opened fURS was unacceptable in ten cases. One case had to be rescheduled after four fURS were opened and deem unacceptable. The most common problem encountered was an inability to pass a laser fiber through the working channel. Other common problems were broken deflection and dried cleaning solution on the instrument tip.    

These authors pose and answer an important question regarding the costs of reusable fURS. At their institution, 16 reusable fURS (13%) were unacceptable for immediate use. In a quarter of these situations, there was dried cleaning solution on the fURS. The remaining three-quarters of these situations could’ve been attributable to manufacturer’s defects and/or the cleaning, sterilization, and packaging that occurs in central processing. 

It is also worth noting that the authors conducted this study over a period of three months. However, the authors do not specify whether the fURS in their inventory were new or had been previously used prior to the initiation of this study. As fURS have a limited lifespan before eventually needing repairs, the age and number of uses of each fURS are important factors. 

Presented by: Scott G. Hubosky

Authors: Scott G. Hubosky, Kelly A. Healy, and Demetrius H. Bagley
Affiliation: Thomas Jefferson University Hospital, Philadelphia, PA

Written by: Michael Owyong (@ohyoungmike), LIFT Fellow, Department of Urology, UC Irvine Medical Center, Orange, CA at 35th World Congress of Endourology – September 12-16, 2017, Vancouver, Canada