Investig Clin Urol.  2018 Sep;59(5):328-334. 10.4111/icu.2018.59.5.328.

In vitro, in vivo, and clinical tests of a novel flexible ureteroscope for the diagnosis and treatment of kidney and ureteral diseases

• Kim DH
• Shin JH
• Choi SY
• You D
• Kim CS
• Park HK

• KMID: 2419416
• DOI: http://doi.org/10.4111/icu.2018.59.5.328

Abstract

PURPOSE
Despite advances in flexible ureteroscopy, the high cost and long repair time of ureteroscopes limit their use in the urology. We compared the performance of a novel flexible ureteroscope (fURS) "˜HF-EH' with that of the two contemporary fURSs "˜URF-P6' and "˜COBRA'.
MATERIALS AND METHODS
We compared in vitro measurements of deflection angle, irrigation flow rate, and image quality between HF-EH and URF-P6 while also inspecting renal collecting systems in five female pigs. For clinical testing, we performed retrograde intrarenal surgeries using HF-EH in four patients. Experienced urologists compared performance parameters (irrigation, convenience, and maneuverability) between the HF-EH and COBRA.
RESULTS
The flow rate of HF-EH (21.0 mL/min) was worse, and its resolution (1.59 line pairs/mm) was inferior to that of URF-P6 (28.7 mL/min and 3.17 line pairs/mm, respectively). However, HF-EH was superior to URF-P6 in terms of loss of deflection angle with the insertion of accessories (1.8% vs. 12.7%). In vivo and clinical testing revealed that the performance parameters of HF-EH were slightly inferior to those of conventional domestic fURSs. We successfully performed retrograde intrarenal surgeries using HF-EH in four patients and achieved stone-free statuses in two. None of the patients exhibited any procedure-related complications.
CONCLUSIONS
Although we observed that two of the three performance parameters of the novel ureteroscope "˜HF-EH' were inferior to those of the conventional ureteroscope, we successfully used HF-EH to perform retrograde intrarenal surgeries in patients. Further studies on performance and durability are warranted for making HF-EH commercially available.

Keyword

Lithotripsy; Nephrolithiasis; Ureteroscopes

MeSH Terms

Diagnosis*
Elapidae
Female
Humans
In Vitro Techniques*
Kidney*
Lithotripsy
Nephrolithiasis
Swine
Ureter*
Ureteral Diseases*
Ureteroscopes*
Ureteroscopy
Urology

Figure

• 

  Fig. 1 In vivo study model of retrograde intrarenal surgery. (A) Pig in dorsal lithotomy position. (B) Practicing on porcine model under the guidance of an experienced endourologist.

• 

  Fig. 2 Total length and maximal deflection of flexible ureteroscopes.

• 

  Fig. 3 USAF 1951 resolution target (A) HF-EH (1.59 line pairs/mm). (B) URF-P6 (3.17 line pairs/mm).

• 

  Fig. 4 Comparison of performance of flexible ureteroscopes in the porcine model. *p-values <0.05.

• 

  Fig. 5 Comparison of performance of flexible ureteroscopes in the clinical test. *p-values <0.05.

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