Performance and durability of leading flexible ureteroscopes

The role of ureteronephroscopy in the diagnosis and treatment of upper-tract disease has expanded dramatically in recent years with technological advances. In a study involving 14 urologists, we measured the practical performance and durability of the most common commercially available flexible ureteroscopes.

Six commercially available flexible ureteroscopes (Circon-ACMI DUR 8, ACMI DUR 8-Elite, Storz 11274AA, Wolf 7325.172-7.5Fr, Wolf 7330.072-9.0 Fr, Olympus URF-P3) were used consecutively 102 times over a 7-month period. Comparative data, including preoperative and postoperative maximal deflection angles and luminosity, were accumulated, as well as a survey of insertion methods, irrigation methods, instruments used in the working channel, visibility, maneuverability, and overall satisfaction. Maintenance records were analyzed to evaluate the need or reason for repair.

Overall satisfaction, visibility, luminosity, and maneuverability were similar for all instruments. The ACMI DUR-8 Elite scored slightly higher than the others, but the difference was not statistically significant. Ureteroscopes were used an average of 10 to 34 times between breakages. The ACMI DUR-8 and DUR-8 Elite instruments had a higher durability score than the others, but with significantly more uses. Channel perforation by a laser fiber was the predominant cause of ureteroscope breakage.

All ureteroscopes performed similarly by objective and subjective criteria. The largest and newest instruments were significantly more durable than the smaller ones, even in the hands of numerous endoscopists. This finding has significant implications for the cost-effectiveness of the various ureteroscopes.