C.F.SHUM1, L.M.MARRERO2, P.AUNG2
Woodlands Health1, Khoo Teck Puat Hospital2
Retrograde intrarenal surgery (RIRS) is effective for stone clearance in the upper urinary tract, and the flexible ureteroscope (fURS) is integral to RIRS. Reusable fURS have high upfront purchase and repair costs, without definite proof of higher stone clearance.
We evaluated the cost effectiveness and surgical outcomes of a disposable fURS (LithoVue™) and two reusable ones (URF-V; Flex-Xc). Covariates included patients’ demographics, type and side of RIRS, pre-stenting and access sheath usage. For lithotripsy cases, total stone burden, infundibulopelvic angle (IPA) and stone clearance were included.
We compared covariates between different fURS with Bonferroni adjustments, and used binary logistic regression to determine predictors for stone clearance. The purchase and repair costs of the two reusable fURS were summated and divided by caseloads to calculate cost-per-case, and was compared to that of LithoVue™.
Our URF-V and Flex-Xc had lifespans of 84.3 and 13.1 months, and were used in 131 and 33 cases respectively. The LithoVue™ was used in 70 cases. 212 of these RIRS cases were performed for urolithiasis, with 68, 118 and 26 cases by LithoVue™, URF-V and Flex-Xc respectively.
The LithoVue™ group had more acute IPA than that in URF-V group. There were no differences between groups for stone burden, but significantly higher stone clearance in LithoVue™ group. Logistic regression associated LithoVue™ with stone clearance favorably.
The cost-per-case of URF-V and Flex-Xc were $461 and $2128 respectively. The fixed cost of LithoVue™ was $2271.
The LithoVue™ allowed highest stone clearance, with comparable cost-per-case to a latest model reusable fURS.