title: Rapid communication: effects of Steris 1 sterilization and Cidex ortho-phthalaldehyde high-level disinfection on durability of new-generation flexible ureteroscopes.
abstract: OBJECTIVE
  The effects of commonly used reprocessing methods on flexible ureteroscope longevity have never been examined. We prospectively studied the effects of Steris 1 sterilization and Cidex ortho-phthalaldehyde (OPA) high-level disinfection (HLD) on the image quality, physical structure, and deflective properties of two new flexible ureteroscopes.
  
  
  METHODS
  Two identical "out-of-the-box" Storz 11278AU1 flexible ureteroscopes (Karl Storz Endoscopy, Tuttlingen, Germany) were sterilized individually using the Steris 1 system (Steris Mentor, Ohio) or disinfected with Cidex OPA (Advanced Sterilization Products, J&J, Irvine, CA) for 100 trials followed by a crossover to the other method for another 100 trials over a period of 1 year. After every five trials, optical quality, angle of deflection, and fiber damage were analyzed in the laboratory. Throughout the study, neither of these ureteroscopes was used clinically.
  
  
  RESULTS
  After 100 trials, ureteroscope 1, which was sterilized initially in the Steris system, had a 12-mm tear on its shaft (noted after the 17th trial), 297 damaged fibers, and a 37% drop in resolution (loss of 3.75 lines/mm). There was no change in deflection from baseline. In contrast, after 100 cycles, ureteroscope 2, which was subjected to HLD with Cidex OPA, had no visible external damage, a 0% change in resolution, 10 damaged fibers, and no change in deflection. After the crossover, ureteroscope 2 developed a semilunar defect that obscured the endoscopic view, whereas there was no further significant damage to ureteroscope 1.
  
  
  CONCLUSIONS
  After 100 cycles, the Steris 1 system rendered the flexible ureteroscope unusable, whereas HLD with Cidex OPA had minimal adverse impact.
authors.affiliation: Department of Urology, University of California Irvine, Orange, California 92868, USA.
authors.forename: Jose Benito A
authors.initials: JB
authors.lastname: Abraham
authors.forename: Corollos S
authors.initials: CS
authors.lastname: Abdelshehid
authors.forename: Hak J
authors.initials: HJ
authors.lastname: Lee
authors.forename: Geoffrey N
authors.initials: GN
authors.lastname: Box
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Deane
authors.forename: Todd
authors.initials: T
authors.lastname: Le
authors.forename: Forrest
authors.initials: F
authors.lastname: Jellison
authors.forename: James F
authors.initials: JF
authors.lastname: Borin
authors.forename: Anthony
authors.initials: A
authors.lastname: Manipon
authors.forename: Elspeth M
authors.initials: EM
authors.lastname: McDougall
authors.forename: Ralph V
authors.initials: RV
authors.lastname: Clayman
mesh_terms: D018592:Cross-Over Studies; D003952:Diagnostic Imaging / Q000379:methods; D004202:Disinfectants / Q000494:pharmacology*; D004203:Disinfection / Q000379:methods*; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods; D004866:Equipment Contamination / Q000517:prevention & control; D004867:Equipment Design; D004868:Equipment Failure; D017743:Equipment Reuse; D005336:Fiber Optic Technology; D006801:Humans; D011446:Prospective Studies; D013997:Time Factors; D020709:Ureteroscopes; D009764:o-Phthalaldehyde / Q000494:pharmacology*
chemical_list: D004202:Disinfectants; D009764:o-Phthalaldehyde