A Comparison of Real-World Utility and Video Quality in Commercially Available Single-Use Ureteroscopes

Single-use (SU) flexible ureteroscopes have been widely adopted as standard-of-care. However, there are few head-to-head studies comparing SU scopes in real-world clinical scenarios. Further complicating these comparisons is the fast pace of incremental improvement and evolution of SU scopes. We compared usability and video quality for SU ureteroscopes in a real-world clinical scenario to provide information for prospective users.

Nine SU and one reusable ureteroscope were compared (Boston Scientific LithoVue, LithoVue Elite, Cook Ascend, Dornier Axis, OTU WiScope, Pusen Uscope, Becton Dickinson Aptra, Richard Wolf digital ureteroscope, Storz Flex-XC1, Olympus URF-V2). First, faculty and residents performed ureteroscopy and reviewed scopes with the University of Wisconsin Flexible Ureteroscopy Evaluation Instrument (image quality, deflection, control, irrigation, access, working channel, and satisfaction; 1-5 scale). Second, using a novel video quality evaluation instrument, blinded reviewers rated resolution, contrast, color, sharpness, glare, depth perception, distortion, and overall quality on a 1-5 scale. Multivariate analysis of variance and analysis of variance analyses were conducted.

167 hands-on and 162 video evaluations were completed. Internal consistency was demonstrated (Cronbach's α > 0.90 for all cases).Hands-on Evaluation:Flex-XC1 and LithoVue Elite had the highest image quality (p < 0.05). Ascend had superior ureteroscopic access (p < 0.05). Uscope ranked lowest in image quality, working channel function, and satisfaction (p < 0.05). LithoVue Elite and Ascend had the highest satisfaction scores (4.64, 4.60, p < 0.05).Video-Based Evaluation:Flex-XC1 and URF-V2 had the highest resolution, contrast, and overall quality (p < 0.05). Flex-XC1 led in color and sharpness (p < 0.05), while Uscope was rated poorly for image resolution, contrast, sharpness, and overall image quality (p < 0.05).

This study is the largest head-to-head comparison to date, providing real-world data for urologists who are prospective purchasers and users of SU ureteroscopes. In the hands-on evaluation, users preferred Cook Ascend, Boston Scientific LithoVue Elite, and Storz Flex-XC1. The Flex-XC1 was rated higher in most categories in video quality evaluation.