Sung Jeffrey C, Springhart W Patrick, Marguet Charles G, L'Esperance James O, Tan Yeh H, Albala David M, Preminger Glenn M
Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Urology. 2005 Nov;66(5):958-63. doi: 10.1016/j.urology.2005.05.033.
To perform an analysis of currently available manufacturer data regarding the character of ureteroscope damage. The high costs associated with the repair of flexible and semirigid ureteroscopes are well documented. Increased knowledge of the etiology of ureteroscope damage should aid urologists in prolonging the lives of these delicate instruments.
We requested data from the four major ureteroscope manufacturers (ACMI, Olympus America, Karl Storz, and Richard Wolf) on the types, speculated causes, costs, and frequency of ureteroscope damage. The results were tabulated in a blinded fashion and analyzed for trends. We then formulated guidelines that could be applied by practicing urologists.
For both flexible and semirigid ureteroscopes, the frequency of repair increased with decreasing ureteroscope diameter and increasing instrument length. The cost of the repair was generally greater for flexible ureteroscopes (mean 4597 dollars) than for semirigid ureteroscopes (mean 2437 dollars). The major causes of flexible ureteroscope damage were working channel damage from laser burn or instrument passage and extreme scope deflection with an indwelling instrument. The primary reasons for semirigid ureteroscope repair included overtorquing and improper handling in the operating room and during sterile processing.
Urologists can minimize the repair costs of flexible and semirigid ureteroscopes by taking precautions to eliminate laser fiber-induced damage and by avoiding overdeflection. Improved storage and handling of these instruments is also necessary. Although small-diameter ureteroscopes are favorable because of their increased mobility and ease of passage, physician and staff awareness of their increased fragility is vital in maximizing the longevity of these commonly used instruments.
对目前可获得的输尿管镜损坏特征的制造商数据进行分析。软性和半硬性输尿管镜的维修成本高昂，这一点已有充分记录。增加对输尿管镜损坏病因的了解应有助于泌尿科医生延长这些精密器械的使用寿命。
我们向四大输尿管镜制造商（ACMI、美国奥林巴斯、卡尔史托斯和理查德·沃尔夫）索取了有关输尿管镜损坏类型、推测原因、成本和频率的数据。结果以盲法列表并分析趋势。然后我们制定了可供执业泌尿科医生应用的指南。
对于软性和半硬性输尿管镜，维修频率均随输尿管镜直径减小和器械长度增加而上升。软性输尿管镜的维修成本通常（平均4597美元）高于半硬性输尿管镜（平均2437美元）。软性输尿管镜损坏的主要原因是激光烧灼或器械通过导致的工作通道损坏以及留置器械时的过度弯曲。半硬性输尿管镜维修的主要原因包括在手术室和无菌处理过程中的过度扭转和操作不当。
泌尿科医生可通过采取预防措施消除激光光纤引起的损伤并避免过度弯曲，将软性和半硬性输尿管镜的维修成本降至最低。改善这些器械的储存和处理也很有必要。尽管小直径输尿管镜因其更高的灵活性和易于通过而更具优势，但医生和工作人员意识到其更高的易碎性对于最大限度延长这些常用器械的使用寿命至关重要。
