Department of Urology, University of California San Diego, San Diego, California, USA.
University of California San Diego, San Diego, California, USA.
J Endourol. 2023 Jun;37(6):628-633. doi: 10.1089/end.2022.0642. Epub 2023 Apr 28.
To evaluate flexible ureteroscope working channels with a 1.06 mm digital borescope (Clarus Medical, Minneapolis, MN) and identify factors contributing to ureteroscope damage over time. We performed a single institutional prospective study of patients undergoing stone surgery using a nondisposable flexible ureteroscope. A 1.06 mm borescope was used to evaluate ureteroscopes before and after surgery. Borescope videos were reviewed by two independent researchers to quantify average pre- and postprocedural damage. Twenty-five procedures were performed with pre- and postprocedural borescope assessment between August 2021 and February 2022. All patients received preoperative CT imaging depicting a mean axial stone size of 14.1 ± 8.4 mm and density of 923.4 ± 458.1 HU. Mean operative time was 63.8 ± 34.0 minutes. The average number an instrument passes through the working channel was 2.1 ± 1.6. Laser was used in 11 cases with mean laser time of 18.8 ± 19.7 minutes and mean total energy of 5.8 ± 4.2 KJ. On preoperative assessment, all ureteroscopes had some form of defect (24% shave, 32% pinhole, 96% dents and scratches, and 28% discolorations). During postoperative assessment, 23/25 (92%) ureteroscopes showed additional damage with an average of 3.7 ± 2.8 imperfections acquired after one use. Significant differences were seen in acquired shavings ( = 0.028) and scratches or dents ( = 0.018). Of the 355 imperfections seen on postoperative evaluation, 0.4% were shave, 3% were pinhole, 85.8% were dents and scratches, and 10.8% were discolorations. The Clarus borescope observed defects after the majority of flexible ureteroscopy procedures for nephrolithiasis. Although such disruptions may not immediately render ureteroscopes nonfunctional, they are more common than previously described and could increase maintenance costs. Further studies are needed to investigate the burden of unit damage per procedure to raise operator awareness and reduce preventable ureteroscope imperfections.
评估使用 1.06mm 数字硬管镜（明尼苏达州明尼阿波利斯市 Clarus Medical）的输尿管镜工作通道，并确定随时间推移导致输尿管镜损坏的因素。
我们对使用非一次性软性输尿管镜进行结石手术的患者进行了单机构前瞻性研究。使用 1.06mm 硬管镜在手术前后评估输尿管镜。两名独立研究人员审查硬管镜视频，以量化平均术前和术后损伤。
2021 年 8 月至 2022 年 2 月期间进行了 25 例手术，术前和术后均进行了硬管镜评估。所有患者均接受术前 CT 成像，显示平均轴向结石大小为 14.1±8.4mm，密度为 923.4±458.1HU。平均手术时间为 63.8±34.0 分钟。仪器通过工作通道的平均次数为 2.1±1.6 次。11 例使用激光，平均激光时间为 18.8±19.7 分钟，平均总能量为 5.8±4.2KJ。术前评估时，所有输尿管镜均存在某种形式的缺陷（24%的刮痕、32%的针孔、96%的凹痕和划痕，以及 28%的变色）。术后评估时，25 个输尿管镜中有 23 个（92%）显示出额外的损伤，每个输尿管镜在使用一次后平均增加了 3.7±2.8 个缺陷。在获得的刮痕（ = 0.028）和划痕或凹痕（ = 0.018）方面存在显著差异。术后评估共观察到 355 个缺陷，其中 0.4%为刮痕，3%为针孔，85.8%为凹痕和划痕，10.8%为变色。Clarus 硬管镜观察到大多数用于肾结石的软性输尿管镜手术后出现的缺陷。尽管这些损坏可能不会立即使输尿管镜失去功能，但它们比以前描述的更为常见，并且可能会增加维护成本。需要进一步研究以调查每次手术单位损坏的负担，以提高操作人员的意识并减少可预防的输尿管镜缺陷。
