Comparison of Surgical Outcomes between Single-Use and Reusable Flexible Ureteroscopes for Renal Stone Management: A Systematic Review and Meta-Analysis

Abstract

Background and Objectives: Disposable flexible ureteroscopes have been widely used because of their cost-effectiveness and higher sterility potential compared with reusable flexible ureteroscopes. This study aimed to compare the surgical outcomes and complication rates in patients who undergo reusable or disposable flexible ureteroscopic stone surgeries (fURS) for urinary stone disease. Materials and Methods: A systematic review and meta-analysis were conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. This systematic review was registered with PROSPERO (CRD42022331291). Clinical trials comparing reusable and disposable fURS for stone disease were found from PubMed, EMBASE, Cochrane Library, and the Web of Science up to March 2022. Participants were patients with upper urinary tract stones; the interventions were reusable or disposable fURS. Outcomes, including stone-free rate, operation time, length of hospital stay, and complication rate, were compared for analysis. Results: Overall, 111 studies were identified, but after removing duplicate studies, 75 studies remained. Thirty-two of these studies were excluded. Of the 43 screened studies, 11 met the eligibility criteria. There was no difference in the stone-free rate (SFR) between disposable and reusable fURS (p = 0.14; OR = 1.36; 95% CI, 0.9 to 2.04). For operation time, no difference was identified between reusable and disposable fURS groups (p = 0.12; MD = -5.31; 95% CI, -12.08 to 1.46). For hospital stay, there was also no difference between the two groups (p = 0.61; MD = -0.03; 95% CI, -0.17 to 0.10). There was no significant difference in complication rate between the two groups (p = 0.85; OR = 0.95; 95% CI, 0.56 to 1.61). Conclusions: There were no differences in the SFR, operation time, length of hospital stay, and complication rate between reusable and disposable fURS. Disposable fURS may be a comparable alternative to reusable fURS.

Keywords: disposable equipment; kidney calculi; meta-analysis; systematic review; ureteroscopes.

Figure 1

Study selection flow chart.

Figure 2

Forest plot for stone-free rate (SFR) between disposable and reusable flexible ureteroscopic stone surgeries (fURS). (A) SFR of disposable and whole reusable fURS. (B) SFR of disposable and digital reusable fURS. (C) SFR of disposable and fiber-optic reusable fURS [17,18,19,20,21,22,23,24,25,26].

Figure 3

Forest plot for stone-free rate (SFR) of disposable and reusable flexible ureteroscopic stone surgeries (fURS) in each study design. (1) SFR of disposable and reusable fURS in randomized clinical trials (RCTs). (2) SFR of disposable and reusable fURS in prospective studies. (3) SFR of disposable and reusable fURS in retrospective study. Study design is written in gray above each analysis (RCT, prospective study, retrospective study). The heterogeneity of each analysis and the applied model are written in gray below each analysis. The heterogeneity between subgroups and the applied model are written in black at the bottom [17,18,19,20,21,22,23,24,25,26].

Figure 4

Forest plot for operation time between disposable and reusable flexible ureteroscopic stone surgeries (fURS). (A) Operation time of disposable and whole reusable fURS. (B) Operation time of disposable and digital reusable fURS. (C) Operation time of disposable and fiber-optic reusable fURS [17,19,20,21,22,23,24,25,26].

Figure 5

Forest plot for length of hospital stay (LOS) between disposable and reusable flexible ureteroscopic stone surgeries (fURS). (A) LOS of disposable and whole reusable fURS. (B) LOS of disposable and digital reusable fURS. (C) LOS of disposable and fiber-optic reusable fURS [17,19,20,22,23,25,26].