Aims: We aimed to evaluate the durability and cost effectiveness of the latest digital flexible ureterescope by comparing it with the conventional fiberoptic one. Materials and Methods: Data of patients who underwent retrograde intrarenal surgery between January 2013 and December 2014 were collected. Fiberoptic Flex-X2 or digital Cobra vision flexible ureteroscopes were used for the procedures. The comparison of both ureteroscopes was performed in terms of patient and stone characteristics, operative outcomes, durability, and cost effectiveness. Results: A total of 105 patients were evaluated for the study. The patient and stone characteristics and operative outcomes were similar between the groups. Overall, 54 and 51 procedures were performed using Flex-X2 and Cobra vision, respectively, before they were sent for renovation. The purchase prices were USD 29,500 for Flex-X2 and USD 58,000 for Cobra vision. Costs of per case were determined as USD 549.29 for Flex-X2 and as USD 1,137.25 for Cobra vision. Per minute working time costs were USD 772.04 and 1,471.33 for Flex-X2 and Cobra vision respectively. Conclusions: The digital Cobra vision has high costs without any difference in durability as compared to Flex-X2. Moreover, it has no benefit over Flex-X2 in terms of surgical outcomes.

Keywords:
Ureteroscopes, Ureteroscopy, Cost-benefit analysis
1.
Marshall, VF: Fiber optics in urology. J Urol 1964: 91: 110–114.
2.
Bagley DH, Rittenberg MH: Percutaneous antegrade flexible ureteroscopy. Urology 1986; 27: 331–334.
3.
Rajamahanty S, Grasso M: Flexible ureteroscopy update: indications, instrumentation and technical advances. Indian J Urol 2008; 24: 532–537.
4.
Cho SY: Current status of flexible ureteroscopy in urology. Korean J Urol 2015; 56: 680–688.
5.
Alenezi H, Denstedt JD: Flexible ureteroscopy: technological advancements, current indications and outcomes in the treatment of urolithiasis. Asian J Urol 2015; 31: 133–141.
6.
Ramachandra MN, Somani BK: Challenges of retrograde ureteroscopy in patients with urinary diversion: outcomes and lessons learnt from a systematic review of literature. Urol Int 2018; 101: 249–255.
7.
Monga M, Best S, Venkatesh R, Ames C, Lee C, Kuskowski M, Schwartz S, Vanlangendock R, Skenazy J, Landman J: Durability of flexible ureteroscopes: a randomized, prospective study. J Urol 2006; 176: 137–141.
8.
Grasso M, Bagley DH: Flexible ureteroscopy with the karl storz flex x2 Ureteroscope; in Grasso M, Bagley DH (eds): Tutlingen, Endo Press GmbH, 2015, pp 8.
9.
Richard Wolf BOA vision & COBRA vision Brochure. URL: https://www.richardwolfusa.com/broschueren/Urology/1163-02.021015USA_BOA_COBRA_Brochure.pdf (accessed November 9, 2017).
10.
Gridley CM, Knudsen BE: Digital ureteroscopes: technology update. Res Rep Urol 2017; 9: 19–25.
11.
Ziemba JB, Matlaga BR: Understanding the costs of flexible ureteroscopy. Minerva Urol Nefrol 2016; 68: 586–591.
12.
Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2014; 240: 205–213.
13.
Abdelshehid C, Ahlering MT, Chou D, Park HK, Basillote J, Lee D, Kim I, Eichel L, Protsenko D, Wong B, McDougall E, Clayman RV: Comparison of flexible ureteroscopes: deflection, irrigant flow and optical characteristics. J Urol 2005; 173: 2017–2021.
14.
Proietti S, Dragos L, Molina W, Doizi S, Giusti G, Traxer O: Comparison of new single-use digital flexible ureteroscope versus nondisposable fiber optic and digital ureteroscope in a cadaveric model. J Endourol 2016; 30: 655–659.
15.
Knudsen B, Miyaoka R, Shah K, Holden T, Turk TM, Pedro RN, Kriedberg C, Hinck B, Ortiz-Alvarado O, Monga M: Durability of the next-generation flexible fiberoptic ureteroscopes: a randomized prospective multi-institutional clinical trial. Urology 2010; 75: 534–538.
16.
Semins MJ, George S, Allaf ME, Matlaga BR: Ureteroscope cleaning and sterilization by the urology operating room team: the effect on repair costs. J Endourol 2009; 23: 903–905.
17.
Defidio L, De Dominicis M, Di Gianfrancesco L, Fuchs G, Patel A: Improving flexible ureterorenoscope durability up to 100 procedures. J Endourol 2012; 26: 1329–1334.
18.
Shah K, Monga M, Knudsen B: Prospective randomized trial comparing 2 flexible digital ureteroscopes: ACMI/Olympus Invisio DUR-D and Olympus URF-V. Urology 2015; 85: 1267–1271.
19.
Multescu R, Geavlete B, Georgescu D, Geavlete P: Improved durability of flex-Xc digital flexible ureteroscope: how long can you expect it to last? Urology 2014; 84: 32–35.
20.
Somani BK, Al-Qahtani SM, de Medina SD, Traxer O: Outcomes of flexible ureterorenoscopy and laser fragmentation for renal stones: comparison between digital and conventional ureteroscope. Urology 2013; 82: 1017–1019.
21.
Pietrow PK, Auge BK, Delvecchio FC, Silverstein AD, Weizer AZ, Albala DM, Preminger GM: Techniques to maximize flexible ureteroscope longevity. Urology 2002; 60: 784–788.
22.
Priorities in Health. The International Bank for Reconstruction and Development/ The World Bank, Washington, DC. https://www.ncbi.nlm.nih.gov/books/NBK10257/.
23.
Tosoian JJ, Ludwig W, Sopko N, Mullins JK, Matlaga BR: The effect of repair costs on the profitability of a ureteroscopy program. J Endourol 2015; 29: 406–409.
© 2018 S. Karger AG, Basel
2018
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.