A Comparison of Real-World Utility and Video Quality in Commercially Available Single-Use Ureteroscopes

Abstract

Introduction:

Single-use (SU) flexible ureteroscopes have been widely adopted as standard-of-care. However, there are few head-to-head studies comparing SU scopes in real-world clinical scenarios. Further complicating these comparisons is the fast pace of incremental improvement and evolution of SU scopes. We compared usability and video quality for SU ureteroscopes in a real-world clinical scenario to provide information for prospective users.

Methods:

Nine SU and one reusable ureteroscope were compared (Boston Scientific LithoVue, LithoVue Elite, Cook Ascend, Dornier Axis, OTU WiScope, Pusen Uscope, Becton Dickinson Aptra, Richard Wolf digital ureteroscope, Storz Flex-XC1, Olympus URF-V2). First, faculty and residents performed ureteroscopy and reviewed scopes with the University of Wisconsin Flexible Ureteroscopy Evaluation Instrument (image quality, deflection, control, irrigation, access, working channel, and satisfaction; 1–5 scale). Second, using a novel video quality evaluation instrument, blinded reviewers rated resolution, contrast, color, sharpness, glare, depth perception, distortion, and overall quality on a 1–5 scale. Multivariate analysis of variance and analysis of variance analyses were conducted.

Results:

167 hands-on and 162 video evaluations were completed. Internal consistency was demonstrated (Cronbach’s α > 0.90 for all cases).

Hands-on Evaluation:

Flex-XC1 and LithoVue Elite had the highest image quality (p < 0.05). Ascend had superior ureteroscopic access (p < 0.05). Uscope ranked lowest in image quality, working channel function, and satisfaction (p < 0.05). LithoVue Elite and Ascend had the highest satisfaction scores (4.64, 4.60, p < 0.05).

Video-Based Evaluation:

Flex-XC1 and URF-V2 had the highest resolution, contrast, and overall quality (p < 0.05). Flex-XC1 led in color and sharpness (p < 0.05), while Uscope was rated poorly for image resolution, contrast, sharpness, and overall image quality (p < 0.05).

Conclusions:

This study is the largest head-to-head comparison to date, providing real-world data for urologists who are prospective purchasers and users of SU ureteroscopes. In the hands-on evaluation, users preferred Cook Ascend, Boston Scientific LithoVue Elite, and Storz Flex-XC1. The Flex-XC1 was rated higher in most categories in video quality evaluation.