Editorial Comment on: Next Generation Single-Use Ureteroscopes: An In Vitro Comparison by Wollin et al.

What is going to become the true role of a single-use flexible ureteroscope? Now that a new supply of single-use ureteroscopes is entering the market, this makes for a very intriguing question. With the emergence of new scopes, the endourology market will become more competitive and the technology will likely continue to advance. The costs may also become more competitive. And what will be the response by the makers of reusable ureteroscopes in both the fiberoptic and digital platforms?

Flexible ureteroscopy has become the major force in the management of kidney and proximal ureteral stones. However, with the increase in use of the flexible ureteroscope, issues have been found in the cost, sterilization/contamination, durability, and longevity of the scopes. Furthermore, digital scopes have dramatically improved our optics; on the contrary, these scopes typically are of a larger caliber (predominantly requiring use of a ureteral access sheath) and may have amplified durability and cost issues.

Along comes the single-use flexible ureteroscope, which over time may be able to overcome some of the shortcomings of the reusable scopes, but can they overcome all of the obstacles? These newer scopes have eliminated sterilization issues and theoretically will eliminate durability issues if one scope can be used for the duration of even complex cases. However, there are still issues with their optics, which are not as robust as their contemporary fiberoptic and digital reusable scopes.

What is the current role of the single-use flexible ureteroscope? A lot of centers will use it primarily for complex upper tract stone cases where the surgeons do not want to jeopardize the deflection capabilities of their reusable scope. Alternatively, they will use it in cases where waiting for reusable scopes in the sterilization process will delay the subsequent cases. Other centers have begun changing over completely to the single-use platform because of their efficiency and cost savings in the sterilization queue. I personally have the single-use scope available for the above reasons, but my workhorse flexible ureteroscopes tend to still be the newer generation fiberoptic scopes because of their narrower caliber and ability to succeed in the vast majority of procedures without complications. However, we have not yet encountered the issues with sterilization and availability that many other centers come across because of the nature of our high-volume center, which has the ability to have many scopes ready at all times. However, I feel that the situation is now imminent, as the sterilization process is evolving in the U.S. hospital system. As it has become more centralized my operating room team and I have noted more damage to my “precious” scopes and delays in receiving them.

This in vitro study compares the new comers in the single-use flexible ureteroscope market, and more are likely on their way. This kind of information will inform urologists of the new technology capabilities and will allow them to determine if they are ready to try this technology. My hope is that as this platform grows and improves technologically, all scopes (reusable, single use, digital, and fiberoptic) will continue to enhance so that surgeons will be satisfied with their equipment, there will be lower overall costs, and we can continue to improve the safety and outcomes for the patients we care for.