PDF(Pubmed)
Abstract：
The introduction of single-use flexible ureteroscopes (suFURSs) in daily practice tends to overcome the main limitations of reusable ureteroscopes (reFURSs), in terms of high acquisition costs, maintenance, breakages and repairing costs, reprocessing and sterilization, as retrograde intrarenal surgery (RIRS) is promoted as first-line treatment of renal stones in most cases. A hybrid strategy implies having both instruments in the armamentarium of endourology and choosing the best strategy for cost-efficiency and protecting expensive reusable instruments in selected high-risk for breakage cases such as large stones of the inferior calyx, a steep infundibulopelvic angle or narrow infundibulum, or abnormal anatomy as in horseshoe and ectopic kidney. In terms of safety and efficiency, data present suFURSs as a safe alternative considering operating time, stone-free, and complication rates. An important aspect is highlighted by several authors about reusable instrument disinfection as various pathogens are still detected after proper sterilization. This comprehensive narrative review aims to analyze available data comparing suFURSs and reFURSs, considering economic, technical, and operative aspects of the two types of instruments, as well as the strategy of adopting a hybrid approach to selecting the most appropriate flexible ureteroscope in each case.
摘要：
在日常实践中引入一次性柔性输尿管镜（suFURSs）倾向于克服可重复使用输尿管镜（reFURSs）的主要局限性，就高昂的收购成本而言，维护,破损和维修费用，再处理和灭菌，因为在大多数情况下，逆行肾内手术（RIRS）被推广为肾结石的一线治疗。混合策略意味着将两种仪器都放在室内泌尿外科的医疗设备中，并选择最佳的成本效益策略，并在选定的高风险破损案例中保护昂贵的可重复使用的仪器，例如下花萼的大石头，陡峭的盆底漏斗角或狭窄的漏斗，或解剖结构异常，如马蹄形和异位肾。在安全和效率方面，考虑到运行时间，数据将suFURSs作为安全的替代方案，无石,和并发症发生率。几位作者强调了一个重要方面，即可重复使用的器械消毒，因为在适当灭菌后仍可检测到各种病原体。这项全面的叙述性审查旨在分析比较suFURSs和reFURSs的可用数据，考虑到经济，技术,以及两种类型仪器的操作方面，以及在每种情况下采用混合方法选择最合适的输尿管软镜的策略。
