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RIRS with disposable or reusable scopes: does it make a difference? Results from the multicenter FLEXOR study.

Vineet Gauhar1, Chu Ann Chai2, Ben H Chew3

  • 1Department of Urology, Ng Teng Fong General Hospital, Singapore.

Therapeutic Advances in Urology
|March 16, 2023
PubMed
Summary

Disposable ureteroscopes may offer an advantage for complex kidney stones, potentially improving stone-free rates in expert hands. Real-world data suggests they are chosen for larger, lower pole, and harder stones, with comparable complication rates to reusable scopes.

Keywords:
RIRSdisposablekidney calculilaserureteroscopy

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Area of Science:

  • Urology
  • Endourology
  • Medical Devices

Background:

  • The increasing availability of single-use ureteroscopes prompts a comparison with traditional reusable scopes.
  • Real-world clinical practice data is crucial for evaluating the practical advantages of different ureteroscope technologies.

Purpose of the Study:

  • To compare the efficacy and outcomes of disposable versus reusable flexible ureteroscopes in treating kidney stones.
  • To determine if disposable ureteroscopes offer a distinct advantage in high-volume clinical settings.

Main Methods:

  • Retrospective analysis of the FLEXOR registry, involving 6663 patients from 20 global centers.
  • Comparison of outcomes between patients treated with reusable (Group 1) and disposable (Group 2) flexible ureteroscopes for retrograde intrarenal surgery (RIRS).

Main Results:

  • Disposable scopes were utilized more frequently for larger (>2 cm), lower pole, and harder stones.
  • Patients using disposable scopes showed a higher stone-free rate (SFR) and fewer residual fragments (RFs) (p < 0.001).
  • Overall complication rates and the need for further treatments were comparable between groups, though disposable scopes were associated with longer operative times in multivariate analysis.

Conclusions:

  • Urologists select disposable ureteroscopes for more challenging stone burdens (larger, lower pole, harder stones).
  • Proper utilization with appropriate lasers and techniques in expert hands can improve single-stage SFR.
  • Real-world evidence supports the utility of disposable ureteroscopes in specific clinical scenarios.