First European experience with LithoVue™ Elite: Multicentre end-user experience and feedback

The LithoVue™ Elite (LVE) is a novel ureteroscope which allows measurement of intrarenal pressure (IRP) during flexible ureteroscopy (fURS). Here we report the survey of first European experience.

A multicentric prospective analysis of end-user experience and feedback was performed for 51 consecutive patients undergoing fURS using LVE across 9 European centres involving 11 surgeons.

A total of 51 cases were analysed with a mean stone size of 9.9 mm (range:4-30 mm), standard ureteral access sheath used in 28 patients (54.9%), with multiple stones in 18 (35.3%) patients. The stone location was lower pole (n = 24; 47.1%), renal pelvis (n = 12; 23.5%), proximal ureter (n = 5; 9.8%), upper pole (n = 4; 7.8%), and other locations (n = 6; 11.7%). The irrigation method used for URS was manual pressure irrigation (n = 25, 49%), gravity with pressure cuff (n = 12; 23.5%), gravity with no pressure cuff (n = 9; 17.6%), and fluid management system or pump (n = 5; 9.8%). A planned pressure threshold (in mmHg) was documented by the surgeon in all cases, with a mean setpoint of ≤ 50 mmHg in 26 (51%) patients, 51-60 mmHg in 13 (25.5%) patients and above 60 mm Hg in 12 (23.5%) patients. Post-procedurally, in 48 (94.1%) cases, surgeons reported that real-time IRP monitoring influenced their surgical technique. The most common intraoperative modifications included reduced manual irrigation in 19 (37.3%), lowered irrigation bag height in 13 (25.50%), adjusted sheath positioning in 10 (19.6%), and reduced or avoidance irrigation pressure in 6 (11.8%) cases. Regarding perceived value, the pressure-sensing scope was rated as highly desirable in 28 procedures (54.9%), and moderately desirable in 16 (31.4%) procedures, yielding a combined desirability rating of 86.3%. Importantly, all 11 surgeons (100%) indicated an intention to continue using LVE, particularly in high-risk patients or complex procedures.

Real time IRP measurement influenced intraoperative technique in majority of cases with surgeons adopting real-time strategies to reduce IRP. The LVE scope was rated as desirable by most users and was universally endorsed for continued use, especially in higher-risk scenarios. These findings support the integration of IRP monitoring as a valuable adjunct in endourologic practice.