Department of Urology, Cristo Re Hospital, Via delle calasanziane 25, Rome, Italy.
J Endourol. 2012 Oct;26(10):1329-34. doi: 10.1089/end.2012.0178. Epub 2012 Jul 11.
Controversy exists in the literature regarding flexible ureterorenoscopy (F-URS) durability, with a variable expected number of uses from a new F-URS. In this study, a tertiary center experience with the use of two consecutive F-URS is reported and suggestions as to how to improve durability further are made.
All F-URS performed in the same tertiary care center between July 2009 and February 2011, with two new instruments Flex-X, were reviewed retrospectively. All renal pathology were included. Ureteral cases were excluded. A 9.5F semirigid ureteroscope was always used at the start for a ureteral optical predilation and to explore the upper urinary tract for possible lithotripsy/laser ablation/biopsy. The F-URS was introduced sequentially to explore the remaining calices. Data pertaining to the procedure were collected. The method of sterilization was complete immersion with Cidex®.
The instruments were substituted after 113 and 102 procedures, respectively. The first F-URS was used for a total operative time of 79 hours and 10 minutes while the second one was used for 71 hours and 25 minutes (mean 75 hours and 15 min). Procedure duration was 15 to 175 minutes (mean 58 min). The flexible instruments were used for a mean of 42 minutes per procedure (range 13-153 min). The indications for F-URS were therapeutic in 75.4% and diagnostic in 22.8% of the cases. For lower pole calculi, the stone was relocated in 65.2% and managed with the nonflexed flexible instrument 90% of the time. The most common causes of damage of F-URS were: Deflection mechanism impairment, inner sheath damage, and fiberoptic bundle breaks.
Increased durability of F-URS was from a variety of factors, a key element of which was the method of sterilization, while routine use of the semirigid instrument initially further contributed significantly to increase the number of F-URS procedures, saving overall costs.
关于软性输尿管镜（F-URS）的耐用性，文献中存在争议，即新的 F-URS 预期的使用次数各不相同。本研究报告了一家三级中心使用连续两套 F-URS 的经验，并提出了进一步提高耐用性的建议。
回顾性分析 2009 年 7 月至 2011 年 2 月在同一家三级保健中心进行的所有 F-URS 检查，使用了两套新的 Flex-X 器械。纳入所有肾病理。排除了输尿管病例。在开始时，始终使用 9.5F 半刚性输尿管镜进行输尿管光学预扩张，并探查上尿路以进行可能的碎石术/激光消融/活检。然后依次使用 F-URS 探查其余的肾盏。收集与手术相关的数据。器械的消毒方法是完全浸泡在 Cidex®中。
两套器械分别在进行 113 次和 102 次操作后更换。第一套 F-URS 的总手术时间为 79 小时 10 分钟，而第二套为 71 小时 25 分钟（平均 75 小时 15 分钟）。手术时间为 15 至 175 分钟（平均 58 分钟）。每个操作过程中，软性器械的使用时间平均为 42 分钟（范围 13-153 分钟）。F-URS 的适应证为治疗性的占 75.4%，诊断性的占 22.8%。对于下极结石，65.2%的结石被重新定位，90%的时间使用非弯曲软性器械进行处理。F-URS 损坏的最常见原因是：偏折机构损坏、内鞘损坏和光纤束断裂。
增加 F-URS 的耐用性有多种因素，其中一个关键因素是消毒方法，而最初常规使用半刚性器械也显著增加了 F-URS 操作次数，从而节省了总体成本。
