Disposable versus reusable ureteroscopes. A prospective multicenter randomized comparison

Introduction: To compare reusable and disposable flexible ureteroscopes in terms of efficacy and safety for patients undergoing RIRS, with specific reference to post-operative complications and infection rates. Materials and methods: Patients with a renal stone eligible for RIRS were enrolled in this multicenter, randomized, clinical trial study. Patients were randomized into two groups: group A (90 patients) underwent RIRS with a reusable flexible ureteroscope and group B (90 patients) were treated with a disposable one. Results: The patients’ demographics, stones features and preoperative urine cultures were comparable between the groups. The SFRs were not significantly different (86,6% and 90,0% for group A and group B respectively, p = 0.11) and the mean cost for each procedure was comparable (2321 € in group A vs 2543 € in group B, p = 0.09). However, the days of hospitalization and of antibiotic therapy were higher in group A (p ≤ 0.05). The overall complication rate in group A was 8.8% whilst in group B it was 3.3% (p ≤ 0.05); in particular, group A exhibited a greater number of major complications (Clavien score IIIa-V). The overall postoperative infections rate was 16.6% in group A and 3.3% in group B (p ≤ 0.05). Furthermore, none of the patients in group B developed urosepsis or had a positive blood culture, while 3 patients in group A did (p < 0.05). Conclusions: The use of disposable ureteroscopes is characterized by significantly lower post-operative complications and infection rates, while having comparable costs and SFRs vis à vis reusable ureteroscopes.