Comparison of a Single Use Digital Ureteroscope to a Fiberoptic Ureteroscope During Retrograde Renolithotripsy

Lazaros Tzelves, Grigorios Raptidis, Marinos Mperdembes, Titos Markopoulos, Grigorios Dellis, Ioannis Siafakas2, Andreas Skolarikos


Introduction: Ureterorenoscopy is a common procedure for treatment
of stone disease. LithoVue is a relatively new entry in urologist
armamentarium and offers digital image as well as single
use nature when compared with traditional fiber-optic, reusable
ureteroscopes. We aim to compare periprocedural outcomes for
stone disease when using these two types of ureteroscopes.
Patients and Methods: Baseline demographic data, perioperative(
procedural time, surgical equipment, complication and
stone-free rates) and postoperative(complication rate, length
of stay) variables were recorded for two groups of patients: one
managed with LithoVue and another with fiber-optic flexible
ureteroscope. Chi-square and Fisher's exact test was used to
compare qualitative data and unpaired t-test for continuous
data, with a statistical significance set at a=0.05.
Results: LithoVue was utilized in 40 and fiber-optic ureteroscope
in 37 patients. The two groups were balanced regarding
their baseline characteristics. Mean operative time for LithoVue
cases was 49.36 ± 14.48 minutes and 62.46 ± 16.60 minutes
for fiber-optic ureteroscope (p<0.001), while intraoperative
stone-free rate for LithoVue was 70% and 43% for fiber-optic
ureteroscope(p<0.005). This difference was also detected 24
hours postoperatively.
Conclusions: Our study indicates that LithoVue can be used
safely as an alternative for flexible fiber-optic ureteroscopes
when managing patients with stone disease. These results
should be confirmed with randomized trials.


LithoVue;fiber-optic ureteroscopy;stone disease;nephrolithiasis;ureterorenoscopy

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Trinchieri A. Epidemiology of urolithiasis: an update. Clin Cases

Miner Bone Metab. 2008 May;5(2):101-6.

Stamatiou KN, Karanasiou VI, LacroixRE,Kavouras NG, Papadimitriou

VT, Chlopsios C et al. Prevalence of urolithiasis in rural Thebes,

Greece. Rural Remote Health. 2006 Oct-Dec;6(4):610. Epub 2006

Dec 8.

Scales CD Jr, Smith AC, Hanley JM, Saigal CS; Urologic Diseases in

America Project. Prevalence of kidney stones in the United States.

Eur Urol. 2012 Jul;62(1):160-5.

Ghani KR, Sammon JD, Karakiewicz PI, Sun M, Bhojani N, Sukumar

S et al. Trends in surgery for upper urinary tract calculi in the USA

using the Nationwide Inpatient Sample: 1999-2009. BJU Int. 2013


Saigal CS, Joyce G, Timilsina AR; Urologic Diseases in America

Project. Direct and indirect costs of nephrolithiasis in an employed

population: opportunity for disease management? Kidney Int. 2005


Butticè S, Sener TE, Proietti S, Dragos L, Tefik T, Doizi S et al. Temperature

Changes Inside the Kidney: What Happens During Holmium:

Yttrium-Aluminium-Garnet Laser Usage? JEndourol. 2016


Shah K, Monga M, Knudsen B. Prospective Randomized Trial Comparing

Flexible Digital Ureteroscopes: ACMI/Olympus Invisio

DUR-D and Olympus URF-V. Urology. 2015 Jun;85(6):1267-71.

Legemate JD, Kamphuis GM, Freund JE, Baard J, Zanetti SP, Catellani

M et al. Durability of Flexible Ureteroscopes: A Prospective Evaluation

of Longevity, the Factors that Affect it, and Damage Mechanisms.

EurUrol Focus. 2018 Mar 10. pii: S2405-4569(18)30079-8.

Salvatore Butticè,TarikEmreSener, Christopher Netsch,Emiliani

E, Pappalardo R, Magno C. LithoVue™: A new single-use digital

flexible ureteroscope. Cent European J Urol. 2016; 69(3): 302–305.

Semins MJ, George S, Allaf ME, MatlagaBR.Ureteroscope cleaning

and sterilization by the urology operating room team: the effect

on repair costs. JEndourol. 2009 Jun;23(6):903-5.

Doizi S, Kamphuis G, Giusti G, Andreassen KH, Knoll T, Osther PJ et

al. First clinical evaluation of a new single-use flexible ureteroscope

(LithoVue™): a European prospective multicentric feasibility study.

World J Urol. 2017 May;35(5):809-818.

Wiseman O, Keeley F, Traxier O, et al. Comparison of anew single-

use digital flexible ureteroscope (LithovueTM)to a non-disposable

fibre-optic flexible ureteroscope in a live porcine model.

J Urol 2016;195:e682.

Dale J, Kaplan AG, Radvak D, Shin R, Ackerman A, Chen T et al.

Evaluation of a Novel Single-Use Flexible Ureteroscope. JEndourol.

Mar 2.

Proietti S, Dragos L, Molina W, et al. Comparison of newsingle-use

digital flexible ureteroscope versus nondisposablefiber optic and

digital ureteroscope in a cadavericmodel. J Endourol 2016;30:655-

Usawachintachit M, Isaacson DS, Taguchi K, Tzou DT, Hsi RS, Sherer

BA et al. A Prospective Case-Control Study Comparing LithoVue, a

Single-Use, Flexible Disposable Ureteroscope, with Flexible, Reusable

Fiber-Optic Ureteroscopes. J Endourol. 2017 May;31(5):468-

Ghani KR, Wolf JS, Jr. What is the stone-free rate followingflexible

ureteroscopy for kidney stones? Nat RevUrol 2015;12:363.

Epstein L, Hunter JC, Arwady MA, et al. New Delhimetallo-betalactamase-

producing carbapenem-resistantEscherichia coli associated

with exposure to duodenoscopes. JAMA 2014;312:1447-1455.

Chang CL, Su LH, Lu CM, et al. Outbreak of ertapenemresistantEnterobacter

cloacae urinary tract infections dueto a contaminated

ureteroscope. J Hosp Infect 2013;85:118-124.

Somani BK, Al-Qahtani SM, de Medina SD, et al. Outcomesof flexible

ureterorenoscopy and laser fragmentationfor renal stones: Comparison

between digital and conventionalureteroscope. Urology


Skolarikos A, Gross AG, Krebs A, Unal D, Berkowsky E, Eltahawy E et

al. Outcomes of Flexible Ureterorenoscopy for Solitary Renal Stones

in the CROES URS Global Study. J Urol. 2015 Jul;194(1):137-43.

Kourambas J, Delvecchio FC, Munver R et al: Nitinol stone retrieval-

assisted ureteroscopic management of lower pole renal calculi.

Urology 2000; 56: 935.

Hollenbeck BK, Schuster TG, Faerber GJ et al: Flexible ureteroscopy

in conjunction with in situ lithotripsy for lower pole calculi. Urology

; 58: 859.

Jung H, Norby B and Osther PJ: Retrograde intrarenal stone surgery

for extracorporeal shock-wave lithotripsy-resistant kidney stones.

Scand J Urol Nephrol 2006; 40: 380

Chung BI, Aron M, Hegarty NJ et al: Ureteroscopic versus percutaneous

treatment for medium-size (1-2-cm) renal calculi. J Endourol

; 22: 343

El-Nahas AR, Ibrahim HM, Youssef RF et al: Flexible ureterorenoscopy

versus extracorporeal shock wave lithotripsy for treatment

of lower pole stones of 10-20 mm. BJU Int 2012; 110: 898

Koo V, Young M, Thompson T et al: Cost-effectiveness and efficiency

of shockwave lithotripsy vs flexible ureteroscopic holmium: yttrium-

aluminium-garnet laser lithotripsy in the treatment of lower

pole renal calculi. BJU Int 2011; 108: 1913.

Atis G, Gurbuz C, Arikan O et al: Ureteroscopic management with

laser lithotripsy of renal pelvic stones. J Endourol 2012; 26: 983.

Rosser C. J., Bare R. L., Meredith J. W. (1999). Urinary tract infections

in the critically ill patient with a urinary catheter. American

Journal of Surgery, 177, 287-290.