Cost of reusable vs. single-use ureteroscopes in complex renal surgeries: a randomized cohort study

To conduct a cost-benefit analysis comparing the latest generation digital reusable ureteroscope (URS) with single-use scopes in endoscopic combined intrarenal surgery (ECIRS).

A single-center, randomized cohort study was conducted during September 2021-June 2024, comparing the two types of URS. Patients undergoing ECIRS were randomized into either the URF-V3 or 7.5Fr flexible single-use URS group based on their physical and stone characteristics. Five newly acquired URF-V3 scopes were utilized. Percutaneous lithotomy was performed using a laser and LithoClast, whereas laser lithotripsy was conducted via URS. The primary endpoints included the cost per procedure and scope durability, whereas the secondary endpoints focused on surgical outcomes.

Overall, 178 patients undergoing ECIRS (n = 89 per group) were analyzed. Four single-use scopes broke, and the URF-V3 scopes required six repairs. The cost per case was $840 for single-use scopes and $1,499 for URF-V3. The URF-V3 scope exhibited a median durability of 13.5 cases before requiring repair. A cost-comparable break-even point for URF-V3 over single-use scopes was achieved in 156 cases. The single-use group required higher total laser energy use (5.0 vs. 3.0 kJ), more frequent URS-assisted access (50.9% vs. 30.3%), and longer operative times (107 vs. 95 min), with no difference in stone-free rates between the groups. Multivariate analysis revealed that scope damage was associated with supine positioning (odds ratio [OR], 6.38), pre-stenting (OR, 7.12), and higher stone density (OR, 1.01).

Single-use flexible ureteroscopes offer economic advantages in ECIRS, particularly in complex case settings, as the aggressive use of flexible URS increases the scope damage risk.