title: Cost Analysis of Flexible Ureteroscope Repairs: Evaluation of 655 Procedures in a Community-Based Practice.
abstract: BACKGROUND
  The frequency of flexible ureteroscopy has increased with the introduction of improved instrumentation. Ureteroscopes allow increased endoscopic access to the ureter and kidney. However, maintenance and repair of scopes may increase the total procedure expense.
  
  
  METHODS
  In 3 years (8/2011-7/2014), 655 flexible ureteroscopies were performed at a single-specialty, urology, ambulatory surgery center. Procedures were performed by 26 board-certified urologists using four Olympus URF P5 flexible ureteroscopes. The instruments were handled by a single team and sterilized through the STERIS System E1. Repairs were performed by the manufacturer on an as needed basis. Patient records were reviewed to determine the preoperative diagnosis, operative time, location and size of the stone, and use of laser or ureteral sheath. The occurrence, nature of flexible ureteroscope damage, and cost of repairs were evaluated.
  
  
  RESULTS
  Of the ureteroscopies performed, 78% was for the treatment of calculi (50.1% in the kidney). Mean stone size was 8.5 ± 0.2 mm, with larger stones (11 mm) located in the kidney. The flexible ureteroscope was advanced over a guidewire (88% of cases); a laser fiber was introduced in 70%, and a ureteral sheath was used in 13.4%. Mean procedure time was 40 minutes. The most common reasons for ureteroscope repair were cloudy lens (16 repairs) and broken optic fibers (9 repairs). There were 31 repairs during the study period (average 21 cases per repair). Flexible ureteroscopes were out of service for an average of 11 days per repair (range 3-20). The total cost of repairs was $233,150 or ∼$7521 per repair. The average repair cost per flexible ureteroscopy performed was $355.
  
  
  CONCLUSIONS
  Expenses associated with instrument repair can significantly impact a procedure's net revenue, thus efforts should be made to minimize instrument breakage. The expense of repairing a flexible ureteroscope per procedure can be significant and needs to be considered when pricing this procedure.
authors.affiliation: 1 Virginia Urology , Richmond, Virginia.
authors.forename: Eugene
authors.initials: E
authors.lastname: Kramolowsky
authors.affiliation: 2 Department of Urology, Baylor College of Medicine , Houston, Texas.
authors.forename: Zachary
authors.initials: Z
authors.lastname: McDowell
authors.affiliation: 1 Virginia Urology , Richmond, Virginia.
authors.forename: Blake
authors.initials: B
authors.lastname: Moore
authors.affiliation: 1 Virginia Urology , Richmond, Virginia.
authors.forename: Brigette
authors.initials: B
authors.lastname: Booth
authors.affiliation: 1 Virginia Urology , Richmond, Virginia.
authors.forename: Nada
authors.initials: N
authors.lastname: Wood
mesh_terms: D003365:Costs and Cost Analysis; D017743:Equipment Reuse; D005336:Fiber Optic Technology / Q000191:economics* / Q000295:instrumentation; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008283:Maintenance / Q000191:economics; D061646:Operative Time; D013242:Sterilization; D014514:Ureteral Calculi / Q000601:surgery*; D020709:Ureteroscopes / Q000191:economics*; D018666:Ureteroscopy / Q000191:economics / Q000295:instrumentation; D014572:Urology