Improving the durability of digital flexible ureteroscopes

Objective To present the damage to digital flexible ureteroscopes after 1 year of use in a tertiary stone center and our strategy to reduce the damage. Materials and Methods Data regarding all procedures performed with 3 new digital flexible ureteroscopes (Olympus URF-V) were collected. We examined the conditions under which the damage occurred and retrieved the manufacturer's repair reports. Two study groups were created. Group 1 included all the procedures performed before the introduction of a set of guidelines for safe use of the digital flexible ureteroscopes and a stepwise credentialing process for new surgeons. Group 2 included all the procedures performed thereafter. Results A total of 141 procedures were performed in 122 patients. Five events of damage occurred in the first study group and were related to working in maximum deflection. In the second group only 3 events occurred. The damage affected the angulation system, working channel, or body shaft. No damage occurred to the imaging system of any ureteroscope. The changes that were made after the first 5 months of use resulted in a significant prolongation of the number of uses before damage occurred for every ureteroscope (10.6 vs 21.6 uses before damage, P = .035). Conclusion The optical system of the new digital ureteroscopes is very durable; however, the overall longevity depends on the correct handling of their use. By following the proposed guidelines for safe use and with monitored training of new users, these instruments can have a significantly longer lifespan.