Department of Urology, Sanador Hospital, Bucharest, Romania.
Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania.
J Med Life. 2022 Aug;15(8):919-926. doi: 10.25122/jml-2022-0110.
The introduction of single-use flexible ureteroscopes (suFURSs) in daily practice tends to overcome the main limitations of reusable ureteroscopes (reFURSs), in terms of high acquisition costs, maintenance, breakages and repairing costs, reprocessing and sterilization, as retrograde intrarenal surgery (RIRS) is promoted as first-line treatment of renal stones in most cases. A hybrid strategy implies having both instruments in the armamentarium of endourology and choosing the best strategy for cost-efficiency and protecting expensive reusable instruments in selected high-risk for breakage cases such as large stones of the inferior calyx, a steep infundibulopelvic angle or narrow infundibulum, or abnormal anatomy as in horseshoe and ectopic kidney. In terms of safety and efficiency, data present suFURSs as a safe alternative considering operating time, stone-free, and complication rates. An important aspect is highlighted by several authors about reusable instrument disinfection as various pathogens are still detected after proper sterilization. This comprehensive narrative review aims to analyze available data comparing suFURSs and reFURSs, considering economic, technical, and operative aspects of the two types of instruments, as well as the strategy of adopting a hybrid approach to selecting the most appropriate flexible ureteroscope in each case.
一次性使用软性输尿管镜（suFURSs）在日常实践中的引入，旨在克服可重复使用软性输尿管镜（reFURSs）的主要局限性，包括高采购成本、维护、破损和维修成本、再处理和消毒，因为逆行肾内手术（RIRS）在大多数情况下被推广为肾结石的一线治疗方法。混合策略意味着在泌尿外科的武器库中同时拥有这两种器械，并根据成本效益选择最佳策略，在选择高破损风险的情况下（如下盏大结石、陡峭的肾盂漏斗角或狭窄的漏斗部，或马蹄肾和异位肾等异常解剖结构）保护昂贵的可重复使用器械。在安全性和效率方面，数据表明 suFURSs 是一种安全的替代方案，考虑到手术时间、结石清除率和并发症发生率。几位作者强调了一个重要方面，即关于可重复使用器械的消毒，因为即使经过适当的消毒，仍能检测到各种病原体。本综述旨在分析比较 suFURSs 和 reFURSs 的现有数据，考虑两种器械的经济、技术和手术方面，以及采用混合方法选择最适合每种情况的软性输尿管镜的策略。
