Does the cleaning technique influence the durability of the < 9F flexible ureteroscope?

Background and Purpose: The fragility of the < 9F flexible ureteroscope lim its its availability to general urology practice. The purpose of this study was to determine whether the technique used to clean the flexible ureteros cope or the number of persons handling the instrument during the cleaning p rocess influenced endoscope breakage or deterioration during regular endour ologic use. Patients and Methods: A new Olympus URF/P3 flexible 7.5F ureteroscope was u sed for each of two 30-day study periods during which a single surgeon used the endoscope for a variety of upper urinary tract procedures. During the first 30-day period (Group 1), the endoscope was leak-proof-pressure tested and cleaned by the endourology support team using the Steris 20 (peroxyace tic acid 35%) technique. During the second 30-day period (Group 2), the end oscope was leak-proof tested and cleaned only by the surgeon using the Cide x (glutaraldehyde 2.4%) technique. A record was kept for each ureteroscopic case to document the patient position, access technique, time the endoscop e was in the urinary tract, instruments passed through the ureteroscope, an d the maximum irrigant pressure used. In addition, a record was made of the number of broken fibers, the degree of flexion and deflexion of the endosc ope, and the problems encountered with the endoscope during the case. Results: The two study groups were similar in terms of the total number of cases performed, the mean time the endoscope was in the urinary tract per c ase, the access approach used, and the use of the ureteral access sheath an d ancillary equipment. In Group 2, the endoscope was used for a longer tota l time (618 minutes v 457 minutes), and access to a lower pole calix was mo re than twice as common as in Group 1. This may explain why more broken fib ers were noted in the instrument used in Group 2 over the study period (eig ht v four broken fibers) than in Group 1. The only breakage occurred as a r esult of the surgeon accidentally activating the laser probe inside the wor king channel of the endoscope in Group 2. Conclusion: The technique and number of personnel involved in the maintenan ce and cleaning of the flexible ureteroscope does not have a significant ef fect on the durability and function of these instruments. It is the arduous demands of the endourologic procedure that influence the durability of the se fragile endoscopes.