Muljibhai Patel Urological Hospital, Nadiad, Gujarat , India
Introduction: Our retrospective cohort of 6669 patients enrolled in the FLEXOR registry was analysed with a primary objective of comparing outcomes of use of disposable and reusable flexible ureteroscopes. Secondary objective of the study was to study the stone free rate and complications in both the groups. Methods: It was a multicentric retrospective study of patients who underwent flexible ureteroscopy ( FURS) from January 2018 to August 2021. Patient less than 18 years, ureteral stones and patients with musculoskeletal abnormalities were excluded. Kolmogorov-Smirnov test was used to check data distribution for normality. Continuous data presented as mean and standard deviation and categorical data as absolute numbers and percentages. Univariable logistic regression analysis was performed to evaluate factors for SFR from PSM population. Multivariable assessment done and estimated as odds ratio (OR) and 95% confidence interval (CI), and p-value. Results: There were 4808( 72.1%) patients in the reusable group ( Group 1 ) and 1855 (27.8%) patients in disposable group ( group 2) . Both the groups were demographically matched. The patients at baseline in the reusable groups were significantly more symptomatic i.e had pain, fever , deranged renal function and culture proven UTI. The mean stone size and stone burden was more in the disposable group (9.62 ± 6.61 vs 11.84 ± 8.59 mm, p = <0.001). As far as the stones > 2cm are concerned they were statistically more in the disposable group ( 3.97% vs 10.84%, p = <0.001) . Lower polar stones were also proportionately more in the disposable group( 43.03% vs 47.06%, p = <0.001) . The stone density was also more in the disposable group ( 967.58 ± 332.14 Vs 1005.48 ± 334.07 , p = <0.001). Operative time was longer in the disposable arm (78.37 ±43.84 vs 57.67 ± 43.84 min , p= <0.001). Significantly more usage of Holmium laser and TFL was noticed in the reusable group (83.67%) and reusable group respectively. Hospital stay was remarkably less in the disposable group (2.52 ± 2.99 vs 3.96 ± 3.54, p = < 0.001) and the residual fragments were statistically more in the reusable group( 25.17% vs 21.78% p = <0.001). On Multivariate analysis Disposable scopes were associated with lesser residual fragments. Conclusions: Disposable scopes are safe and effective and provide better stone free rates. They are more likely to be used in large burden and lower polar stones. SOURCE OF Funding: -
