软性输尿管镜的耐用性：对使用寿命、影响因素和损坏机制的前瞻性评估。

Durability of Flexible Ureteroscopes: A Prospective Evaluation of Longevity, the Factors that Affect it, and Damage Mechanisms.

机构信息

Department of Urology, AMC University Hospital, Amsterdam, The Netherlands.

出版信息

Eur Urol Focus. 2019 Nov;5(6):1105-1111. doi: 10.1016/j.euf.2018.03.001. Epub 2018 Mar 11.

DOI:10.1016/j.euf.2018.03.001

PMID:29534873

Abstract

BACKGROUND

Flexible ureteroscopy is an established treatment modality for evaluating and treating abnormalities in the upper urinary tract. Reusable ureteroscope (USC) durability is a significant concern.

OBJECTIVE

To evaluate the durability of the latest generation of digital and fiber optic reusable flexible USCs and the factors affecting it.

DESIGN, SETTING, PARTICIPANTS: Six new flexible USCs from Olympus and Karl Storz were included. The primary endpoint for each USC was its first repair. Data on patient and treatment characteristics, accessory device use, ureteroscopy time, image quality, USC handling, disinfection cycles, type of damage, and deflection loss were collected prospectively.

INTERVENTION

Ureteroscopy.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

USC durability was measured as the total number of uses and ureteroscopy time before repair. USC handling and image quality were scored. After every procedure, maximal ventral and dorsal USC deflection were documented on digital images.

RESULTS AND LIMITATIONS

A total of 198 procedures were performed. The median number of procedures was 27 (IQR 16-48; 14h) for the six USCs overall, 27 (IQR 20-56; 14h) for the digital USCs, and 24 (range 10-37; 14h) for the fiber optic USCs. Image quality remained high throughout the study for all six USCs. USC handling and the range of deflection remained good under incremental use. Damage to the distal part of the shaft and shaft coating was the most frequent reason for repair, and was related to intraoperative manual forcing. A limitation of this study is its single-center design.

CONCLUSIONS

The durability of the latest reusable flexible USCs in the current study was limited to 27 uses (14h). Damage to the flexible shaft was the most important limitation to the durability of the USCs evaluated. Prevention of intraoperative manual forcing of flexible USCs maximizes their overall durability.

PATIENT SUMMARY

Current flexible ureteroscopes proved to be durable. Shaft vulnerability was the most important limiting factor affecting durability.

摘要

背景

软性输尿管镜检查术是评估和治疗上尿路异常的一种成熟治疗手段。可重复使用输尿管镜（reusable ureteroscope，USC）的耐用性是一个重要关注点。

目的

评估最新一代数字和光纤可重复使用软性输尿管镜的耐用性及其影响因素。

设计、地点、参与者：纳入奥林巴斯和卡尔史托斯的 6 根新型软性输尿管镜。每根输尿管镜的主要终点是首次维修。前瞻性收集患者和治疗特征、附件使用、输尿管镜检查时间、图像质量、输尿管镜处理、消毒循环、损伤类型和偏折损失的数据。

干预

输尿管镜检查。

观察指标和统计分析

以维修前的总使用次数和输尿管镜检查时间来衡量输尿管镜的耐用性。输尿管镜处理和图像质量进行评分。每次手术后，在数字图像上记录最大腹侧和背侧输尿管镜偏折。

结果和局限性

共进行了 198 例操作。6 根输尿管镜的总中位数操作次数为 27 次（IQR 16-48；14 小时），数字输尿管镜为 27 次（IQR 20-56；14 小时），光纤输尿管镜为 24 次（范围 10-37；14 小时）。在整个研究过程中，所有 6 根输尿管镜的图像质量均保持较高水平。随着使用次数的增加，输尿管镜处理和偏折范围保持良好。轴的远端和轴涂层的损伤是维修的最常见原因，与术中手动用力有关。本研究的局限性在于其单中心设计。