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Purpose: Single-use flexible ureteroscopes offer the advantage of being consistently functional and perfect for immediate clinical use right “out of the box.” Cost is the barrier to widespread acceptance of these instruments. Economic models have been put forth which compare the expense of acquiring and maintaining reusable flexible ureteroscopes to that of using single-use flexible ureteroscopes.However, one poorly defined variable in these models is the frequency of encountering an unsuitable reusable flexible ureteroscope at the beginning of a case. We sought to define this in a consecutive series of patients undergoing flexible ureteroscopy.

Patients and Methods: Prospective analysis of all consecutive cases requiring flexible ureteroscopy over three months was undertaken. A combination of fiberoptic and digital flexible ureteroscopes comprised the available inventory. Per protocol, these instruments were grossly cleaned in the endourology suite after use, and sent to central processing for final cleaning, sterilization (STERRAD) and packaging. Repairs were managed by a third party repair service when needed. Ureteroscopes were defined as acceptable if they provided reasonable visualization, deflection, an open working channel that would accept passage of instruments and no evidence of gross contamination or overt damage/deformity.

Results: Of 228 consecutive cases, a total of 261 reusable flexible ureteroscopes were unwrapped and 93 (90%) cases were initiated with the first instrument opened. In 11 (9.0%) cases, the initial ureteroscope opened was unacceptable for use and required opening an additional ureteroscope(s). In 7 cases, at least 2 instruments were opened. Also, 3,4, and 5 instruments needed to be opened in 1 case each. One case had to be rescheduled after 4 consecutive instruments were opened and all were unsuitable. Of 17 unfit instruments, 19 problems were noted and included broken deflection (4), dried cleaning solution on the instrument tip (4), inability to pass a laser fiber through the working channel (5), digital camera dislodged from distal bending rubber (2), crushed proximal shaft (1), digital image failure (1), lens trouble causing optical failure (1) and a missing sterilization cap (1). Considering all 119 instruments opened, 17 (14%) were unsuitable for immediate use.

Conclusions: In up to 12.6% of cases, the initially opened reusable flexible ureteroscope is not fit for initiation of the procedure. This rate may vary among institutions depending on repair, processing, and nursing practices but represents one area where single use devices can fill an essential and immediate role.

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Ureteroscopy, Quality, Safety, Equipment Proccessing, Single Use Ureteroscopes, Cost Saving, STERRAD, urology


Medicine and Health Sciences | Urology


Presented at the 2018 House Staff Quality Improvement and Patient Safety Conference

Bad Out of the Box: A Report on Pre-operative Failure Rates of Reusable Flexible Ureteroscopes at a Single Institution

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