Most problems with flexible ureteroscopes attributed to surgeon error, inadequate maintenance

Multiple problems can occur with flexible ureteroscopes—used to diagnose and treat a range of conditions in the urinary tract—and these problems are often related to surgeon error or inadequate maintenance, as reported in a study.

For the study, researchers searched the Manufacturer User and Facility Device Experience database to identify all recorded events related to flexible ureteroscopes within a 10-year period. They collected data on problem and cause, timing, complications and injury, prolonged anaesthesia, and early termination of procedure. The severity of events was graded using a validated tool.

A total of 206 events were identified (reusable/single use ratio, 2.5:1) and included in the analysis. These events into 20 different categories, which included image loss (26.7 percent), scope removal difficulty (13.6 percent), scope damage from basket (4.4 percent), scope tip detachment (5.8 percent), and contamination (4.9 percent).

Faulty device was the leading cause for an event related to single-use scopes (86.4 percent) but was seldom the case for events related to reusable scopes (2 percent). Patient injury occurred in 21.8 percent of events, all of which occurred with reusable scopes.

There were no records of death. However, several major complications were documented, including complete avulsion of the ureter (3.4 percent) and fully entrapped scope necessitating open surgery (2.9 percent).

Compared with reusable scopes, single-use scopes had a better safety profile. However, the use of single-use scopes was more likely to result in early termination (71.1 percent vs 37.3 percent; p<0.001), mostly due to sudden image loss.

The findings suggest that many of the problems related to the use of flexible ureteroscopes can be avoided through correct surgeon technique and robust maintenance services.