Editorial Comment on: In Vitro Evaluation of Single-Use Digital Flexible Ureteroscopes: A Practical Comparison for Patient-Centered Approach (From: Marchini GS,Batagello CA,Monga M,et al. J Endourol 2018;32:184–191)

In 1987, Bagley first introduced the concept of a modular, disposable ureteroscope to circumvent the expense needed to repair/replace fragile reusable ureteroscopes. ¹ Since then, approximately a half a dozen disposable ureteroscopes have been developed and described. ^2,3 Their development mirrors that of reusable flexible ureteroscopes in their evolution from having unilateral to bidirectional flexion capabilities and fiberoptic to digital imaging.

This article by Giovanni et al. compares two single-use flexible ureteroscopes with a reusable fiberoptic ureteroscope. They evaluate and compare the technical characteristics, optics, and deflection capabilities of three ureteroscopes (LithoVue, Pusen, and Storz Flex X ² ). Although minor differences were found, the three ureteroscopes in general demonstrated comparable characteristics in all areas tested. The authors advocate that understanding the unique characteristics of available ureteroscopes may facilitate a patient-centered approach when choosing which ureteroscope to utilize for individual patients.

This article adds to the body of literature demonstrating that disposable flexible ureteroscopes have comparable characteristics to reusable ureteroscopes. Single-use flexible ureteroscopes have also demonstrated comparable clinical outcomes to patients treated with reusable ureteroscopes. ^4,5 A potential barrier to adopting single-use flexible ureteroscopes is a concern over cost; however, Taguchi and coworkers found that use of the Lithovue disposable flexible ureteroscope had a comparable cost per use compared with use of the reusable Olympus URF-P6™ ($2852 vs $2800) at their institution. ⁶

Despite decades of technological refinement in designing reusable flexible ureteroscopes, ureteroscope fragility and the expense needed to maintain optimal functioning ureteroscopes for use on patients remain a challenge. We have reached a point in time wherein disposable ureteroscopes are now comparable to reusable ureteroscopes in performance and price/use. Manufacturers develop products to fill a need. Disposable ureteroscopes help fill the need of providers having improved access to fully functional flexible ureteroscopes.