AUA 2022: Single-use Ureteroscopes and New Technology: What is in Store?

(UroToday.com)  The Saturday AUA afternoon plenary session kicked off with a session by Dr. Ben Chew regarding single use ureteroscopes with an update on new single use ureteroscope technology and future directions in this space. The first single use ureteroscope that was introduced into the market was the LithoVue by Boston Scientific in 2016.

At the time, the main concerns regarding single-use or disposable ureteroscopes were whether these units could show consistent performance, always be available, have an upgradeable platform and lastly be affordable. The EDGE consortium performed a randomized clinical trial comparing reusable ureteroscopes to single-use disposable ureteroscopes1. The main outcomes studies included stone free rates with secondary outcomes assessing length of surgery, laser time, basketing time, deflection of the scope at the beginning and end of the case and a rating of the scope as it handled by the surgeons. The results from this study showed significantly better upward (p=<0.001) and downward deflection (P=0.006) for the single use scope as compared to the reusable scope. This was true for both pre and post operatively. Stone free rates and operative time were comparable. Surgeons also preferred the optics and visualization of the reusable scope however the scope had a high failure rate with and averaged only 6.6 uses per scope.

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Dr. Chew outlined the concerns with regards to ureteroscopy specifically pyelovenous and pyelotubular back flow that is thought to occur at pressures of 30 mmH20 and whether this can have infectious implications resulting in higher rates of sepsis. He highlighted the new Boston Scientific Lithovue Elite scope that is currently only available in Canada. This is a single use digital ureteroscope with pressure sending capabilities. The deflection capabilities of this new scope are very similar to the older generation however significant improvements have been made with visualization and color to those approaching the optics of reusable scopes.

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With regards to intrarenal pressure and pyelovenous backflow Dr. Chew’s team performed porcine experiments with the new Lithovue Elite unit looking at intra-renal pressures with various irrigation setups including irrigation to gravity, bag at pressure of 150 mmHg and 300 mmHg, manual 50 cc syringe and self-filling syringe2. Additionally, a ureteral access sheath was also deployed at various anatomic landmarks including the renal pelvis, UPJ and distal ureter. The results showed the lowest and comparable intra-renal pressures with the 12/14 Fr and 11/13 Fr ureteral access sheaths. Unsurprisingly the lowest pressures were when the sheath was deployed in the renal pelvis. Out of the various irrigation mechanisms the manual syringe showed the highest intra-renal pressures. Dr. Chew noted that currently the safe zone for intra-renal pressure is not known however the Lithovue Elite device now gives us a reliable method to study this. Other scopes on the market were also highlighted including Clarion Medical Pusen Scope, the BARD Wi-scope and the Innovex EU-Scope.

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Dr. Chew went on to highlight some emerging technologies including Auris Surgical new Monarch platform for robotic ureteroscopy that has been recently approved for use in the United States3. The Monarch platform allows for robotic control of the ureteroscope with an X-Box type controller with excellent visualization. The benefits of this platform include stability, ease of navigation, ergonomic and can reduce radiation exposure to the surgeon. Additionally, new software can allow for automated actions such as sized detection, laser settings, control of respiration, electromagnetic targeting, and artificial intelligence applications.

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Overall, endourology continues to be an exciting subspecialty of urology that continues to innovate and produce new technology for better patient care and outcomes. Dr. Chew concludes that the future is bright for Endourology!


Presented by: Dr. Ben Chew MD, FRCSC, Department of Urologic Sciences, University of British Columbia
Moderators: Dr. Hassan Razvi MD, FRCSC & Dr. Anthony Smith MD

Written by: Sohrab Naushad Ali MD, MSc, FRCSC Endourology Fellow, Department of Urology, University of California Irvine, @sohrabnaushad on Twitter during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.

References:
1. Knudsen BE, Posid T, Scimeca A, et al: MP65-19 Reusable Digital Flexible Ureteroscope Vs. A Single-Use Flexible Ureteroscope In The Treatment Of Urolithiasis: An Edge Consortium Prospective Randomized Clinical Trial. Journal of Urology 2021; 206.
2. Bhojani N, Shalabi N, Wong KFV, et al: MP14-04 In Vivo And Bench Testing Of A Concept Single-Use Ureteroscope Bsc Compared To Reference Single Use And Reusable Ureteroscopes. Journal of Urology 2022; 207.
3. Monarch Surgical System. https://www.aurishealth.com/monarch-platform.