Perspectives on technology: To use or to reuse, that is the endoscopic question - a systematic review of single-use endoscopes.

Abstract

There is a growing interest in single-use endoscopes within urology, with multiple new devices now available. Although these devices have been evaluated to show efficacy on benchtop-models, there is a paucity of data comparing clinical outcomes. The aim of this meta-analysis was to compare clinical outcomes of single-use endoscopes to reusable endoscopes to better define their role within urology. A systematic search of electronic databases was performed. All studies comparing clinical outcomes of participants undergoing urological procedures with single-use endoscopes to those treated with reusable endoscopes were included. Results are reported in accordance with the PRISMA 2020 statement. Twenty-one studies on 3943 participants were identified. Six different single-use flexible ureteroscopes and two different single-use flexible cystoscopes were assessed. There were no differences in mean post-operative infection rates (4.0% vs 4.4%, p=0.87) or overall complication rates (11.5% vs 11.9%, p=0.88) between single-use and reusable endoscopes. For patients undergoing flexible ureteroscopy there were no differences in operative time (mean difference -0.05 minutes, p=0.96), hospital length of stay (mean difference 0.06 days, p=0.18), or stone-free rates (74% vs 74.3%, p=0.54) between the single-use and reusable flexible ureteroscope groups. This study is the largest to compare clinical outcomes of single-use endoscopes to reusable endoscopes within urology, and has demonstrated no difference in LOS, complication rates and SFR, with a reduced OT associated with single-use FC. It also highlights that the cost-efficiency and environmental impact of single-use endoscopes is largely dependent on the caseload and reprocessing facilities available within a given institution. Urologists can therefore feel confident that whether they choose to "use, or to reuse" for the financial and environmental implications, they can do so without negatively impacting patient outcomes.