Impressive Performance: New Disposable Digital Ureteroscope Allows for Extreme Lower Pole Access and Use of 365 μm Holmium Laser Fiber

Abstract

BACKGROUND Since the development of the first flexible ureteroscope, in 1964, technological advances in image quality, flexibility, and deflection have led to the development of the first single-use digital flexible ureteroscope, LithoVue™ (Boston Scientific, Marlborough, MA). With respect to reusable fiber-optic and now digital ureteroscopes, there is an initial capital cost of several thousand dollars (USD) as well as, controversy regarding durability, the cost of repairs and the burdensome reprocessing steps of ureteroscopy. The single-use LithoVue eliminates the need for costly repairs, the occurrence of unpredictable performance, and procedural delays. Renal stones located in the lower pole of the kidney can be extremely challenging as extreme deflections of greater than 160° are difficult to maintain and are often further compromised when using stone treatment tools, such as laser fibers and baskets. This case describes an initial use of the LithoVue digital disposable ureteroscope in the effective treatment of lower pole calculi using a 365 μm holmium laser fiber. CASE REPORT A 35-year-old female, with a medical history significant for chronic bacteriuria, and recurrent symptomatic culture proven urinary tract infections, underwent localization studies. Retrograde ureteropyelography demonstrated two calcifications adjoining, measuring a total of 1.4 cm, overlying the left renal shadow. Urine aspirated yielded clinically significant, >100,000, Escherichia coli and Streptococcus anginosus bacteriuria, which was felt to be originating from the left lower calix. This case used the newly FDA-approved LithoVue flexible disposable ureteroscope. The two stones were seen using the ureteroscope passed through an ureteral access sheath in the lower pole calix. A 365 μm holmium laser fiber was inserted into the ureteroscope and advanced toward the stones. There was no loss of deflection as the ureteroscope performed reproducibly. The laser was used for more than 4000 pulses at 15 W, producing mucoid debris and fragments. A 1.9F nitinol basket was, then, used to extract the fragments, and the patient was rendered stone free. Treatment success was confirmed by plain abdominal film obtained 1 week after stent removal. CONCLUSION The LithoVue system single-use digital flexible ureteroscope provides an economical advantage over both reusable digital and fiber-optic ureteroscopes. The LithoVue system uses the enhanced image resolution of the digital complementary metal oxide semiconductor imager, similar to other reusable digital ureteroscopes, while maintaining the small ureteroscope size of a flexible fiber-optic ureteroscope, allowing for consistent and effective lower pole access. Deflection characteristics are maintained even when thicker laser fibers are passed through the working channel.