Editorial Comment on: Let's Get to the Point: Comparing Insertion Characteristics and Scope Damage of Flat-Tip and Ball-Tip Holmium Laser Fibers by Carlos et al. (From: Carlos EC,Li J,Young BJ,et al. J Endourol 2019;33:22–26;DOI: 10.1089/end.2018.0229)

Carlos et al. performed an interesting follow-up study ¹ by evaluating the insertional forces and damage to a ureteroscope liner when inserting a standard flat-tip and ball-tip laser fibers. The authors used a strain gauge to measure the force required for insertion of each laser fiber and >600 passes at angles of 30°, 45°, 60°, and 90° were performed. The main finding was that average insertional force for the ball-tip fiber was significantly lower at all deflection angles than for flat-tip laser fibers.

Although the ball-tip fiber outperformed the flat-tip fiber, it is important to keep in mind that passing any laser fiber while a flexible ureteroscope is deflected can lead to costly damage to the ureteroscope lining. The authors acknowledge that a new ball-tip fiber was used for each trial, and with what is known about ball-tip degradation a follow-up study examining a more realistic clinical scenario is warranted. The cost of using and repairing reusable ureteroscopes is becoming increasingly more relevant with the introduction of a variety of disposable flexible ureteroscopes on the market.