Breakage Costs in Flexible Ureteroscopy: Digital vs. Fiberoptic Modalities.- Beyond the Abstract

The cost of sustaining a flexible ureteroscopy program is one of its major complexities. This was further complicated by the recent industry introduction of single-use scopes, shaking up the world of ureteroscopy and adding another convoluted variable into this already multifaceted equation. A real-world and up to date cost comparison of these ureteroscope modalities is lacking in the literature.

The purpose of this work is to investigate the costs of fiberoptic vs. digital vs. disposable ureteroscopes, with the goal of making it easier to understand and extrapolate to a variety of institutions. The major expenditures within a ureteroscopy program include costs of purchase, maintenance, and reprocessing. However, the total cost per procedure is dynamic, as previous scope purchase expenses are continuously diluted as the number of procedures increases. Most cost-benefit analyses published to this point1 have reported total costs per procedure as a fixed price after a certain number of cases. Here we present a more dynamic model, taking this dilution effect into account.

One of our study’s key findings is the difference in repair costs per procedure between fiberoptic and digital ureteroscopes, with lower costs per procedure for the fiberoptic modality at $90.62. Interestingly, when analyzing the cumulative number of procedures before scope failure, we detected significantly greater endurance in our digital ureteroscope in the early period of our digital ureteroscopy program, which impacted its respective repair costs per procedure when less than 400 procedures were performed. This finding suggests that smaller programs, with a lower procedural volume, may benefit from acquiring digital ureteroscopes.

It should be emphasized that our contract model was based on a fixed repair price based on scope type, regardless of the type or severity of the damage. Although we understand that contract variations exist, the primary objective of this study was to analyze the impact of the costs of repair for two different, commonly utilized, reusable ureteroscope modalities on the total cost of a ureteroscopy program. We found that repairs alone accounted for approximately 50% of the total cost per procedure in our program, irrespective of the scope modality. This is similar to previously published rates in the literature.2,3

Another unique aspect of this work is the cost comparison to a single-use ureteroscope. This revealed a much higher break-even point for the fiberoptic modality, despite a smaller difference of $63.58 in total costs per procedure after 800 cases. The fiberoptic modality required ~400 cases to bring their repair costs per procedure to the same value as the single-use scope, while digital scopes needed only 260 procedures. This may be attributable to some degree to improved scoped endurance in our initial implementation of digital ureteroscopy. This is another factor to consider when deciding on the optimal balance of the number and type of each scope to include in a single institution’s ureteroscope portfolio.

Written by: William E. Ito, Bristol B. Whiles, Daniel A. Igel, & Wilson R. Molina, Department of Urology, The University of Kansas Health System, Kansas City, KS.


  1. Martin CJ, McAdams SB, Abdul-Muhsin H, Lim VM, Nunez-Nateras R, Tyson MD, et al. The Economic Implications of a Reusable Flexible Digital Ureteroscope: A Cost-Benefit Analysis. J Urol. 2017;197(3 Pt 1):730-5.
  2. Landman J, Lee DI, Lee C, Monga M. Evaluation of overall costs of currently available small flexible ureteroscopes. Urology. 2003;62(2):218-22.
  3. Borofsky MS DC, York NE, et al. Comprehensive costs associated with fiberoptic and digital flexible ureteroscopes at a high volume teaching hospital. Urol Pract. 2017;4:187-92.
Read the Abstract