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一次性使用与可重复使用膀胱镜用于输尿管支架取出的前瞻性随机试验。

Prospective Randomized Trial of Single-Use Reusable Cystoscope for Ureteral Stent Removal.

作者信息

Johnson Brett A, Raman Jay D, Best Sara L, Lotan Yair

机构信息

Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.

出版信息

J Endourol. 2023 Oct;37(10):1139-1144. doi: 10.1089/end.2023.0134.

Abstract

Reusable cystoscopes are associated with risks of cross-contamination, need for chemical reprocessing, mechanical breakdown, maintenance costs, and labor for cleaning. A sterile, single-use cystoscope may reduce or eliminate the source of these infections while also decreasing exposure to reprocessing chemical agents. In this multicenter, randomized trial, we sought to compare single use with reusable endoscopes for ureteral stent removal. A three-center, randomized, dual-arm postmarket clinical trial was performed to compare the single-use cystoscope (Ambu A/S) with standard-of-care flexible reusable cystoscopes for outpatient ureteral stent removal. A total of 102 patients were randomized and evaluated from baseline through day 10 postprocedure. Primary endpoint was successful stent removal. Secondary endpoints were time from preparation to disposal/reprocessing, adverse events (AEs), and clinician satisfaction. A total of 102 subjects were randomized in a 1:1 manner. The successful stent removal rate was 51/51 (reusable) and 50/51 (single use). One patient required the conversion to reusable cystoscope owing to grasper passage issue. Median time from prep for the procedure to disposal/prep for reprocessing was 10.2 minutes for the single use and 18.4 minutes for the reusable ( < 0.001). There was no difference in clinician satisfaction between both arms. There was no difference in AEs between arms and no device causal attribution for any AE reports. There was one serious AE necessitating hospitalization for infection in the reusable arm. The randomized-controlled trial of single-use cystoscopes reusables showed comparable device success with significant time savings for single use and equivalent clinician satisfaction. The study was registered on clinicaltrials.gov database (NCT04829461) on April 2, 2021.

摘要

可重复使用的膀胱镜存在交叉污染风险、需要进行化学再处理、机械故障、维护成本以及清洁所需的人力。无菌一次性膀胱镜可能会减少或消除这些感染源,同时还能减少接触再处理化学试剂的机会。在这项多中心随机试验中,我们旨在比较一次性与可重复使用的输尿管支架取出内镜。我们进行了一项三中心、随机、双臂上市后临床试验,以比较一次性膀胱镜(Ambu A/S)与用于门诊输尿管支架取出的标准护理柔性可重复使用膀胱镜。共有102名患者被随机分组,并从基线评估至术后第10天。主要终点是成功取出支架。次要终点是从准备到处置/再处理的时间、不良事件(AE)以及临床医生满意度。共有102名受试者以1:1的方式随机分组。成功取出支架的比例为51/51(可重复使用组)和50/51(一次性使用组)。一名患者因抓取器通过问题需要转换为可重复使用的膀胱镜。一次性使用组从手术准备到处置/再处理准备的中位时间为10.2分钟,可重复使用组为18.4分钟(<0.001)。两组临床医生满意度无差异。两组不良事件无差异,且任何不良事件报告均无器械因果归因。可重复使用组有1例严重不良事件因感染需要住院治疗。一次性膀胱镜与可重复使用膀胱镜的随机对照试验表明,器械成功率相当,一次性使用可显著节省时间,临床医生满意度相当。该研究于2021年4月2日在clinicaltrials.gov数据库注册(NCT04829461)。

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