Presentation (CTI)

OBJECTIVES: Percutaneous nephrolithotomy (PCNL) is a key procedure for managing large and complex kidney stones. Achieving a high stone-free rate (SFR) is critical to reduce recurrence and complications. While post-procedural inspection is clinically important, no prior studies have systematically assessed usage patterns of flexible cysto-nephroscopes for detecting residual stones at the end of PCNL.
METHODS: A double-blinded online survey was conducted in June 2024 among 100 urologists across six countries (US, Germany, France, UK, Italy, Spain). The survey captured data on flexible cysto-nephroscope usage (reusable vs. single-use), annual PCNL volume, and institutional affiliation (defined as where the urologist spent ≥60% of their time). Analyses included Fisher’s exact test, Chi-squared test, and logistic regression using RStudio.
RESULTS: Overall, 94% of urologists reported using a flexible cysto-nephroscope to inspect for remaining stones/stone fragments at the end of PCNL. Among them, 83% used a reusable and 17% used a single-use scope. Notably, the UK was the only country with a higher preference for single-use (56%). There was no significant difference of the usage of a flexible cysto-nephroscope for this purpose in private institutions (97%) vs public institutions (92.31%) (p=0.6621). No significant association were found between the likelihood of using a flexible cysto-nephroscope for inspection and the annual PCNL volume at the department (p=0.702) or institutional affiliation (p=1).
CONCLUSIONS: This study highlights a strong global preference for using flexible cysto-nephroscope to inspect for residual stones at the end of PCNL procedures, with a predominant use of reusable flexible cysto-nephroscope. While clinical outcomes remain a primary driver, further research is needed to explore the underlying reasons for these preferences and to evaluate the cost-effectiveness of reusable versus single-use flexible cysto-nephroscopes, especially in relation to institutional budgets, infection control, and long-term resource utilization.