MP44-17: Comparison of Operative Efficiency and Effectiveness between a Dual Lumen and Single Lumen Ureteroscope for Ureteroscopic Stone Removal

Andrew Brevik, Rohit Bhatt*, Kalon Morgan, Sohrab Ali, Akhil Peta, Sina Zarandi, Luke Limfueco, Rajiv Karani, Lillian Xie, Raphael Arada, John Sung, Francis Jefferson, Egor Parkhomenko, Daniel Lama, Shoaib Safiullah, Pengbo Jiang, Roshan Patel, Ralph Clayman, Jaime Landman, Orange, CA

Introduction: Dual lumen flexible ureteroscopes (DLFU) have yet to be compared head-to-head in a clinical trial with single lumen flexible ureteroscopes (SLFU). Our prospective, randomized study sought to evaluate the efficacy, efficiency, and surgeon device preference during upper urinary tract stone management with SLFU vs. DLFU.

Methods: Seventy-nine patients undergoing flexible ureteroscopy and laser lithotripsy for proximal ureteral or renal stones between 2016 and 2020 were randomized to either SLFU or DLFU. The overall time for ureteroscopy, laser lithotripsy, and stone basketing were recorded. Procedural efficiency and effectiveness based on stone clearance rate and stone-free status were calculated using preoperative and postoperative computed tomography (CT) imaging and 3D Slicer CT-based, stone volume determination. Postoperative surgeon surveys addressed ergonomics and overall ureteroscope performance.

Results: Although linear stone burden was not statistically different between the two groups, preoperative stone volume was almost two-fold greater in the dual lumen group (267 mm3 vs. 132 mm3, p = 0.03). Despite the larger stone volume, DLFU provided a 4-minute shorter lithotripsy time than SLFU (2 min vs. 6 min, p = 0.02) with a significantly better stone clearance rate (7.1 mm3/min vs. 3.7 mm3/min, p = 0.03). True stone-free rate, specifically a complete absence of stone fragments as seen on postoperative CT, was 48% for DLFU compared to 26% for SLFU (p = 0.05). The dual lumen exceeded the single lumen ureteroscope in all surgeon-evaluated performance metrics.

Conclusions: DLFU surpassed SLFU in surgical efficiency and effectiveness by providing a faster lithotripsy procedure and a higher absolute stone-free rate. Based on surgeon questionnaires, DLFU was also ergonomically superior to SLFU.

Source of Funding: The UCI Urology Curiosity and Innovation Laboratory has received support from Richard Wolf Endoscopy® in the form of funding and ureteroscopes.