Cost of reusable vs. single-use ureteroscopes in complex renal surgeries: a randomized cohort study.

PURPOSE: To conduct a cost-benefit analysis comparing the latest generation digital reusable ureteroscope (URS) with single-use scopes in endoscopic combined intrarenal surgery (ECIRS). METHODS: A single-center, randomized cohort study was conducted during September 2021-June 2024, comparing the two types of URS. Patients undergoing ECIRS were randomized into either the URF-V3 or 7.5Fr flexible single-use URS group based on their physical and stone characteristics. Five newly acquired URF-V3 scopes were utilized. Percutaneous lithotomy was performed using a laser and LithoClast, whereas laser lithotripsy was conducted via URS. The primary endpoints included the cost per procedure and scope durability, whereas the secondary endpoints focused on surgical outcomes. RESULTS: Overall, 178 patients undergoing ECIRS (n = 89 per group) were analyzed. Four single-use scopes broke, and the URF-V3 scopes required six repairs. The cost per case was $840 for single-use scopes and $1,499 for URF-V3. The URF-V3 scope exhibited a median durability of 13.5 cases before requiring repair. A cost-comparable break-even point for URF-V3 over single-use scopes was achieved in 156 cases. The single-use group required higher total laser energy use (5.0 vs. 3.0 kJ), more frequent URS-assisted access (50.9% vs. 30.3%), and longer operative times (107 vs. 95 min), with no difference in stone-free rates between the groups. Multivariate analysis revealed that scope damage was associated with supine positioning (odds ratio [OR], 6.38), pre-stenting (OR, 7.12), and higher stone density (OR, 1.01). CONCLUSION: Single-use flexible ureteroscopes offer economic advantages in ECIRS, particularly in complex case settings, as the aggressive use of flexible URS increases the scope damage risk.