Comparison of disposable flexible ureteroscopes with flexible video and digital ureteroscopes

Relevance. The appearance of disposable flexible ureteroscope on the market is a significant breakthrough in endourology. Routine implementation of flexible ureteropyeloscopy in clinical practice implies significant costs for initial acquisition and subsequent expensive maintenance of endoscopes. In addition, after plasma sterilization it is not always possible to achieve complete sterility in the working channel of the instrument, which can lead to the development of infectious and inflammatory complications with severe consequences for the patient. Reliable (and recommended by the manufacturer as the main method) site sterilization of ureteroscopes is possible using the method of gas sterilization, for example, with the use of ethylene oxide (EO), however, this sterilization method is rarely used and implies a long period of airing of a flexible endoscope (at least 30 hours after sterilization cycle), which reduces the possible frequency of application of the ureteroscope. The solution of the two above-mentioned problems was the development of disposable models of flexible ureteroscope. Purpose. To evaluate the advantages and disadvantages of the new disposable flexible ureteroscopes: LithoVue ™, NeoFlex ™, Polyscope ™, Pusen ™, SemiFlex Scope ™, Flexor Vue ™ and compare them with the fiber and digital reusable flexible ureteroscope manufactured by KARL STORZ. Materials and methods. A literary search for information on disposable ureteroscopes was carried out on two search bases: PUBMED and Google Scholar. As search phrases used: single-use ureteroscope, novel ureteroscope, flexible ureteroscope, retrograde nephroscope, disposable ureteroscope. A comparative analysis of disposable flexible ureteroscopes with flexible fiber-optic and digital ureteroscope from KARL STORZ was carried out. The following parameters were analyzed: ease of manipulation in the kidney, change in control with an additional tool inserted into the working channel (conductor or basket), optical characteristics, irrigation system, and financial profitability. Results. Disposable flexible ureteroscopes are comparable to reusable ureteroscope in terms of ease of management in the renal cavity system, image quality, angle of deflection, taking into account the presence or absence of additional tools in the working channel. With regard to the crushing of the stones of the lower group of cups, the fiber optic ureteroscope Flex-X2 (KARL STORZ) demonstrated its superiority. The profitability, subject to the readiness of the initial investment in the purchase of Flex-X2, also turned out to be on the side of a reusable instrument: the average lifetime of the instrument is 21 hours, and repair-replacement will require about 350 thousand rubles, which, given the initial cost of disposable ureteroscopes from 50 to 90 thousand rubles, is more economically advantageous offer. Conclusion. The appearance of disposable flexible ureteroscope is undoubtedly a breakthrough in endourology. Disposable ureteroscopes may be recommended for use, but improved kidney control and lower prices would lead to a wider use of them in clinical practice.