Identifying factors associated with need for flexible ureteroscope repair: a Western Endourology STone (WEST) research consortium prospective cohort study

Maintenance of flexible ureteroscopes can involve high costs and administrative burden. Instrument fragility necessitates eventual repair, rendering scopes inaccessible during refurbishment. We conducted a multi-institutional prospective cohort study to identify perioperative factors influencing flexible ureteroscope durability. Patients undergoing flexible ureteroscopy (URS) at six United States endourology centers were enrolled between August 2014 and June 2015. Surgeon self-reported concern and satisfaction with scope performance as well as upward and downward angles of deflection for each scope tip were measured before and after each procedure. The need for scope repair was determined by the operating surgeon at the time of the procedure and recorded. 424 URS cases using 74 flexible ureteroscopes were identified. Scope repair was required in 28 cases (6.6%) involving 26 scopes (35.1%). Upon univariate analysis, shorter patient height, absence of guidewire use, presence of a ureteral access sheath (UAS), longer procedure time, larger stone size, lithotrite type, surgeon training level, and self-reported concern were associated with scope repair. Upon multivariate analysis, UAS use (OR = 2.53, p = 0.005) and degree loss of scope upward flexion during a case (OR = 1.02, p = 0.03) increased the odds of a scope needing repair while the use of safety guidewire decreased the odds of a scope repair (OR = 0.50, p = 0.045). Lithotrite use and surgeon concern were associated with degree loss of scope upward flexion. The use of a UAS, absence of a safety guidewire, and the loss of upward ureteroscope flexion should be considered when evaluating means of optimizing reusable ureteroscope durability.

Urolithiasis. 2017 Dec 09 [Epub ahead of print]

Kazumi Taguchi, Jonathan D Harper, Marshall L Stoller, Brian D Duty, Mathew D Sorensen, Roger L Sur, Manint Usawachintachit, David T Tzou, David L Wenzler, Dylan Isaacson, Angela Xu, Carissa Chu, Uwais B Zaid, Eric R Taylor, Krishna Ramaswamy, Thomas Chi

Department of Urology, University of California, San Francisco, 400 Parnassus Ave., Sixth Floor, Suite A610, San Francisco, CA, 94143, USA., Department of Urology, University of Washington, Seattle, USA., Department of Urology, Oregon Health and Science University, Portland, USA., Department of Urology, University of California, San Diego, USA., School of Medicine, University of California, San Francisco, USA., Department of Urology, University of California, San Francisco, 400 Parnassus Ave., Sixth Floor, Suite A610, San Francisco, CA, 94143, USA. .