The new digital flexible ureteroscopes: 'size does matter'--increased ureteric access sheath use!

Area of Science:

• Urology
• Medical Devices
• Endourology

Background:

• Flexible ureteroscopy is a key procedure for treating kidney stones.
• Advancements in ureteroscope technology aim to improve visualization and efficacy.
• Newer digital flexible ureteroscopes have larger distal tip diameters than older fiber-optic models.

Purpose of the Study:

• To compare the utilization of ureteral access sheaths between new-generation digital and old-generation fiber-optic flexible ureteroscopes.
• To assess the impact of digital ureteroscopes on sheath-related complications and outcomes.

Main Methods:

• A randomized controlled trial involving 140 patients with kidney stones.
• Patients were assigned to either an old-generation fiber-optic ureteroscope or a new-generation digital ureteroscope.
• Data collected included sheath necessity, sheath-related complications, and JJ stent usage.

Main Results:

• Ureteral access sheaths were used significantly more often with digital ureteroscopes (p = 0.00174).
• Two patients in the digital scope group experienced distal ureteric perforation from the introducer sheath, versus none in the fiber-optic group.
• Total procedures analyzed were 157 (80 fiber-optic, 77 digital).

Conclusions:

• New-generation digital flexible ureteroscopes are associated with a statistically significant increase in ureteral access sheath use.
• The larger diameter of digital scopes necessitates greater sheath utilization.
• Increased sheath use may lead to higher morbidity and healthcare expenses, despite improved scope performance.