Disposable versus Reusable Ureteroscopes: A Prospective Multicenter Randomized Comparison

Giorgio Bozzini,1 Beatrice Filippi,2 Sulieman Alriyalat,3 Alberto Calori,1 Umberto Besana,1 Alexander Mueller,4 Dmitri Pushkar,5 Javier Romero-Otero,6 Antonio Pastore,7 Maria Chiara Sighinolfi,2 Salvatore Micali,2 Carlo Buizza,1 Bernardo Rocco2 1Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy; 2Urology Department, Policlinico of Modena, Modena, Italy; 3Urology Department, Al-Balqa Applied University, Al-Salt, Jordan; 4Department of Urology, University Hospital Zurich, Zurich, Switzerland; 5Urology Department First Moscow State Medical University, Moscow, Russia; 6Department of Urology, Hospital Universitario 12 de Octubre, Madrid, Spain; 7Urology Department, Università “La Sapienza”, Latina, ItalyCorrespondence: Beatrice FilippiUrology Department, Policlinico di Modena, Via del Pozzo, n. 71, Modena, 41125, ItalyTel +39 3403904011Email beatrice.filippi87@gmail.comPurpose: To compare reusable and disposable flexible ureteroscopes in terms of efficacy and safety for patients undergoing Retrograde Intrarenal Surgery (RIRS).Patients and Methods: Patients with a renal stone eligible for RIRS were enrolled in this multicenter, randomized, clinical trial study. Patients were randomized into two groups: group A (90 patients) underwent RIRS with a reusable flexible ureteroscope and group B (90 patients) were treated with a disposable one.Results: The patients’ demographics, stone features and pre-operative urine cultures were comparable between the groups. The Stone Free Rates (SFRs) were not significantly different (86.6% and 90.0% for group A and group B, respectively, p=0.11) and the mean cost for each procedure was comparable (2321 € in group A vs 2543 € in group B, p=0.09). However, the days of hospitalization and of antibiotic therapy were higher in group A (p ≤ 0.05). The overall complication rate in group A was 8.8% whilst in group B it was 3.3% (p ≤ 0.05); in particular, group A exhibited a greater number of major complications (Clavien score IIIa-V). The overall postoperative infection rate was 16.6% in group A and 3.3% in group B (p ≤ 0.05). Furthermore, none of the patients in group B developed urosepsis or had a positive blood culture, while 3 patients in group A did (p< 0.05).Conclusion: The use of disposable ureteroscopes is characterized by significantly lower post-operative complications and infection rates, while having comparable costs and SFRs vis à vis reusable ureteroscopes. Clinical Trial Registration Number: ISRCTN92289221.Keywords: RIRS, disposable ureteroscope, reusable ureteroscope, infection