Early Outcomes of the Reprocessing and Reuse of Disposable Flexible Ureteroscope for Renal Stone Management: A Single-Center Study in Nepal

Abstract

Introduction: The use of disposable flexible ureteroscopy for the management of renal stone has become an established procedure since last few years however discarding the instrument after single use possess a financial burden to the patient in resource limited countries.   Therefore, it’s an attempt to assess the cost effectiveness and the safety profile of the procedure by reprocessing   and reusing the disposable flexible Ureteroscope. Methods: It was a hospital-based prospective observational cross-sectional study. LithoVue, Single Use Flexible Ureteroscope from Boston Scientific device was used for the procedure. Operative time, level of intra-operative performance alteration and fluoroscopic guided stone clearance were assessed. Early postoperative complications, durability of each scope, postoperative ultrasonographic stone clearance were also assessed. The cause of immature scope damage was also identified. Results: Thirty-eight   disposable flexible ureteroscope were used for 186 procedures of mean age of 42.67 ± 14.88 years. The mean size and average CT scan hardness of the stones were 14.65 ± 9.82mm and 1017 ± 340HU respectively. The number of disposable flexible ureteroscope and the patient ratio was found to be 1:5. The mean operative time was 44.26 ± 25.16 minutes. The immature damage of the scope was seen in 9 scopes. Five patients (2.76%) developed urinary tract infection. Sonography after 6 weeks following the procedure showed that 11 patients (6%) had Clinically Significant Residual Fragment (>5mm) whereas 32 patients (17%) had Clinically Insignificant Residual Fragment (< 5mm). Conclusion: Reprocessing and reuse of disposable flexible ureteroscope is safe and cost-effective procedure with minimal probability of cross-infection and immature scope damage if reprocessing of the device is well supervised.