The First UK Experience with Single-use Disposable Flexible Cystoscopes: An In-depth Cost Analysis, Service Delivery and Patient Satisfaction Rate with Ambu® aScope™ 4 Cysto
Main Article Content
Abstract
Background and Objective
Ambu® aScope™ 4 Cysto is a single-use disposable flexible cystoscope that allows clinicians to perform the procedure at any time and any place. It simplifies workflow, frees up resources and allows clinicians to treat more patients. Our trust became the first in the UK and Europe to utilise these cystoscopes. An in-depth evaluation was performed to test its practicality, cost analysis and patient satisfaction against traditional reusable flexible cystoscopes.
Material and Methods
We compared the cost of using Ambu® aScope™ 4 Cysto to perform flexible cystoscopies in 20 patients prospectively against traditional flexible cystoscopes in 20 patients retrospectively. The cost of the equip-ment, reprocessing, cleaning supplies and maintenance were consulted from relevant departments and companies. All prospective patients were also given a patient satisfaction questionnaire to complete. An unpaired t-test was used to analyse the data.
Results
Our study revealed that it costs £135.23 and £166.33 on average to perform a flexible cystoscopy using Ambu® aScope™ 4 Cysto and the traditional flexible cystoscopes, respectively. Our patient survey revealed that there was a statistical significance between the patient experience using the single-use disposable scopes compared with the traditional reusable flexible cystoscopes (P = 0.0455). Further, 95% of patients also preferred a single-use disposable cystoscope over traditional reusable ones, given the option.
Conclusion
Single-use disposable flexible cystoscopes are a safe and cost-efficient method of performing the procedure. It is portable and proves to be a simple, efficient and practical way of performing a flexible cystoscopy in an inpatient, outpatient, or emergency setting.
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How to Cite
Wong, A., Phan , Y., Thursby, H., & Mahmalji, W. (2021). The First UK Experience with Single-use Disposable Flexible Cystoscopes: An In-depth Cost Analysis, Service Delivery and Patient Satisfaction Rate with Ambu® aScope™ 4 Cysto. Journal of Endoluminal Endourology, 4(1), e29-e44. https://doi.org/10.22374/jeleu.v4i1.120
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Original Article
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References
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19. Seyam RM, Zeitouni OM, Alsibai TM, AlAyoub AJ, Al-Qassab OM, AlDeiry Mhd A, et al. The grasper-integrated disposable flexible cystoscope is comparable to the reusable, flexible cystoscope for the detection of bladder cancer. Sci Rep. 2020;10(1):13495. http:// dx.doi.org/10.1038/ s41598-020-70424-0
20. Talso M, Emiliani E, Baghdadi M, Orosa A, Servian P, Barreiro A, et al. The new grasper-integrated single use flexible cystoscope for double J stent removal: Evaluation of image quality, flow and flexibility. World J Urol. 2017;35(8):1277–83. http:// dx.doi.org/10.1007/ s00345-016-1987-z
21. Donato P, Honore M, Zana T, Pokorny M, Bowes W, Meyer JP, et al. Prospective trial of single-use, flexible cystoscope for ureteric double-J stent removal: Cost and utility analysis. J Clin Urol. 2020;13(2):160–3. http://dx.doi.org/10.1177/2051415819860377
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24. Fuselier HA, Mason C. Liquid sterilization versus high level disinfection in the urologic office. Urology. 1997;50(3):337–40. http://dx.doi.org/10.1016/ S0090-4295(97)00218-5
25. McGill JJ, Schaeffer AJ, Gonzalez CM. Durability of flexible cystoscopes in the outpatient setting. Urology. 2013;81(5):932–7. http://dx.doi.org/10.1016/j. urology.2013.01.029
26. Rutala WA, Weber DJ. Reprocessing semicritical items: Current issues and new technologies. Am J Infect Control. 2016;44(5 Suppl):e53–62. http://dx.doi. org/10.1016/j.ajic.2015.12.029
27. Noronha AM, Brozak S. A 21st century nosoco-mial issue with endoscopes. BMJ. 2014;348(mar19 8):g2047–g2047. http://dx.doi.org/10.1136/bmj.g2047
28. Chang C-L, Su L-H, Lu C-M, Tai F-T, Huang Y-C, Chang K-K. Outbreak of ertapenem-resistant Enterobacter cloacae urinary tract infections due to a contaminated ureteroscope. J Hosp Infect. 2013;85(2):118–24. http:// dx.doi.org/10.1016/j.jhin.2013.06.010
29. Koo VSW, O’Neill P, Elves A. Multidrug-resistant NDM-1 Klebsiella outbreak and infection control in endoscopic urology. BJU Int. 2012;110(11 Pt C):E922–6. http://dx.doi.org/10.1111/j.1464-410X.2012.11556.x
30. Wendelboe AM, Baumbach J, Blossom DB, Frank P, Srinivasan A, Sewell CM. Outbreak of cystoscopy related infections with Pseudomonas aeruginosa: New Mexico, 2007. J Urol. 2008;180(2):588–92. http:// dx.doi.org/10.1016/j.juro.2008.04.003
31. Moore B, Forman A. An outbreak of urinary Pseu-domonas aeruginosa infection acquired during urological operations. Lancet. 1966;2(7470):929–31. http:// dx.doi.org/10.1016/S0140-6736(66)90535-6
32. Jimeno A, Alcalde MM, Ortiz M, Rodríguez A, Al-caraz B, Vera F. Outbreak of urinary tract infections by Salmonella spp. after cystoscopic manipulation. Actas Uroló Esp (English Edn). 2016;40(10):646–9. http://dx.doi.org/10.1016/j.acuro.2016.02.005
33. Lamas Ferreiro JL, Álvarez Otero J, González González L, Novoa Lamazares L, Arca Blanco A, Bermúdez Sanjurjo JR, et al. Pseudomonas aeruginosa urinary tract infections in hospitalized patients: Mortality and prognostic factors. PLoS One. 2017;12(5):e0178178. http://dx.doi.org/10.1371/journal.pone.0178178
34. OYong K, Coelho L, Bancroft E, Terashita D. Health care-associated infection outbreak investigations in out-patient settings, Los Angeles County, California, USA, 2000–2012. Emerg Infect Dis. 2015;21(8):1317–21. http://dx.doi.org/10.3201/eid2108.141251
35. Echols RM, Palmer DL, King RM, Long GW. Multidrug-resistant Serratia marcescens bacteriuria related to urologic instrumentation. South Med J. 1984;77(2):173–7. http://dx.doi.org/10.1097/00007611-198402000-00010
36. Climo MW, Pastor A, Wong ES. An outbreak of Pseudomonas aeruginosa related to contaminated urodynamic equipment. Infect Control Hosp Epidemiol. 1997;18(7):509–10. http://dx.doi.org/10.2307/30141192
37. British Association of Urological Surgeons (BAUS). Flexible Cystoscopy [Internet]. Available from: https:// www.baus.org.uk/_userfiles/pages/files/Patients/Leaf-lets/Flexible%20cystoscopy.pdf
38. Herr HW. Should antibiotics be given prior to outpatient cystoscopy? A plea to urologists to practice antibiotic stewardship. Eur Urol. 2014;65(4):839–42. http:// dx.doi.org/10.1016/j.eururo.2013.08.054
39. Herr HW. The risk of urinary tract infection after flexible cystoscopy in patients with bladder tumor who did not receive prophylactic antibiotics. J Urol. 2015;193(2):548–51. http://dx.doi.org/10.1016/j. juro.2014.07.015
40. Baston EL, Wellum S, Bredow Z, Storey G, Palmer A, Dellen DV, et al. Office-based ureteric stent removal is achievable, improves clinical flexibility and quality of care, whilst also keeping surgeons close to their patients. Cent European J Urol. 2018;71(2):196–201.
41. Maurice JB, Siau K, Sebastian S, Ahuja N, Wesley E, Stableforth W, et al. Green endoscopy: A call for sustainability in the midst of COVID-19. Lancet Gastroenterol Hepatol. 2020;5(7):636–8. http://dx.doi. org/10.1016/S2468-1253(20)30157-6
42. Pichler P-P, Jaccard IS, Weisz U, Weisz H. Interna-tional comparison of health care carbon footprints. Environ Res Lett. 2019;14(6):064004. http://dx.doi. org/10.1088/1748-9326/ab19e1
43. Vaccari M, Tudor T, Perteghella A. Costs associated with the management of waste from healthcare
facilities: An analysis at national and site level. Waste Manag Res. 2018;36(1):39–47. http://dx.doi. org/10.1177/0734242X17739968
44. Davis NF, McGrath S, Quinlan M, Jack G, Lawrents-chuk N, Bolton DM. Carbon footprint in flexible ureteroscopy: A comparative study on the environmental impact of reusable and single-use ureteroscopes. J Endourol. 2018;32(3):214–17. http://dx.doi.org/10.1089/ end.2018.0001
45. Lilholt Sørensen B, Grüttner H. Comparative study on environmental impacts of reusable and single-use bronchoscopes. AJEP. 2018;7(4):55. http://dx.doi. org/10.11648/j.ajep.20180704.11
46. Ambu. Sustainability report 2019/20 [Internet]. [cited 2021 Feb 16]. Available from: file:///C:/Users/Anton.Wong/ Desktop/AMBU/Sustainability_Report_2019_20.pdf
2. Samplaski MK, Jones JS. Two centuries of cystoscopy: The development of imaging, instrumentation and synergistic technologies. BJU Int. 2009;103(2):154–8. http://dx.doi.org/10.1111/j.1464-410X.2008.08244.x
3. Kennedy TJ, Preminger GM. Flexible cystoscopy. Urol Clin North Am. 1988;15(3):525–8.
4. Ambu. AMBU® ASCOPETM 4 CYSTO single-use. New possibilities [Internet]. [cited 2021 Jan 30]. Available from: https://www.ambu.com/endoscopy/ urology/cystoscopes/product/ambu-ascope-4-cysto
5. Ambu_UK. Congratulations to the urology team at @WyeValleyNHS for being the first users of the Ambu aScope 4 Cysto in the Europe! [Internet]. 2020. Available from: https://twitter.com/Ambu_UK/ status/1334440735463059456
6. Phan YC, Cobley J, Mahmalji W. Cost analysis and service delivery on using Isiris αTM to remove ure-teric stents. JELEU. 2018;1(1):e3–16. http://dx.doi. org/10.22374/jeleu.v1i1.5
7. NHS Employers. NHS terms and conditions (AfC) pay scales—Hourly [Internet]. [cited 2021 Feb 16]. Available from: https://www.nhsemployers. org/pay-pensions-and-reward/nhs-terms-and-con-ditions-of-service---agenda-for-change/pay-scales/ hourly
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9. Neoscope. NeoFlex—Flexible, single use cystoscopeTM [Internet]. [cited 2021 Jan 30]. Available from: https:// neoscope2020.com/?portfolio=flexible-cystoscope10. Coloplast. Isiris® innovative digital single use solution for stent removal in adults [Internet]. [cited 2021 Jan 30]. Available from: https:// www.coloplast.co.uk/ isiris-en-gb.aspx
11. Bourguignon C, Destrumelle A-S, Koch S, Grumblat A, Carayon P, Chopard C, et al. Disposable versus reusable biopsy forceps in Gl endoscopy: A cost-minimization analysis. Gastrointest Endosc. 2003;58(2):226–9. http://dx.doi.org/10.1067/ mge.2003.341
12. Hogan RB, Santa-Cruz R, Weeks ES, Alexander L, Hogan RB 3rd. Cost-minimization analysis of jumbo reusable forceps versus disposable forceps in a high-volume ambulatory endoscopy center. Gastrointest Endosc. 2009;69(2):284–8. http://dx.doi.org/10.1016/j. gie.2008.04.062
13. Scotland K, Wong VKF, Chan JYH, Tawfiek E, Chiura A, Chew BH, et al. Evaluation of a single-use flexible cystoscope: A multi-institutional international study. J Endourol. 2020;34(9):981–6. http://dx.doi. org/10.1089/end.2020.0002
14. Manatakis DK, Georgopoulos N. Reducing the cost of laparoscopy: Reusable versus disposable laparoscopic instruments. Minim Invasive Surg. 2014;2014:1–4. http://dx.doi.org/10.1155/2014/408171
15. Pietropaolo A, Hughes T, Tear L, Somani BK. Comparison of ureteric stent removal procedures using reusable and single-use flexible cystoscopes following ureteroscopy and lasertripsy: A micro cost analysis. Cent European J Urol. 2020;73(3):342–8. http://dx.doi. org/10.5173/ceju.2020.0159
16. Oderda M, Antolini J, Falcone M, Lacquaniti S, Fasolis G. Cost-effectiveness analysis of a single-use digital flexible cystoscope for double J re-moval. Urologia. 2020;87(1):29–34. http://dx.doi. org/10.1177/0391560319859797
17. Butticè S, Sener TE, Netsch C, Emiliani E, Pappalardo R, Magno C. LithoVueTM: A new single-use digital flexible ureteroscope. Cent European J Urol. 2016;69(3):302–5.
18. Doizi S, Kamphuis G, Giusti G, Palmero JL, Patterson JM, Proietti S, et al. First clinical evaluation of a new single-use flexible cystoscope dedicated to double-J stent removal (IsirisTM): A European prospective multicenter study. World J Urol. 2017;35(8):1269–75. http://dx.doi.org/10.1007/s00345-016-1986-0
19. Seyam RM, Zeitouni OM, Alsibai TM, AlAyoub AJ, Al-Qassab OM, AlDeiry Mhd A, et al. The grasper-integrated disposable flexible cystoscope is comparable to the reusable, flexible cystoscope for the detection of bladder cancer. Sci Rep. 2020;10(1):13495. http:// dx.doi.org/10.1038/ s41598-020-70424-0
20. Talso M, Emiliani E, Baghdadi M, Orosa A, Servian P, Barreiro A, et al. The new grasper-integrated single use flexible cystoscope for double J stent removal: Evaluation of image quality, flow and flexibility. World J Urol. 2017;35(8):1277–83. http:// dx.doi.org/10.1007/ s00345-016-1987-z
21. Donato P, Honore M, Zana T, Pokorny M, Bowes W, Meyer JP, et al. Prospective trial of single-use, flexible cystoscope for ureteric double-J stent removal: Cost and utility analysis. J Clin Urol. 2020;13(2):160–3. http://dx.doi.org/10.1177/2051415819860377
22. Ambu. AMBU® AVIEWTM 2 ADVANCE A high-quality, portable full-HD monitor for single-use endoscopy [Internet]. [cited 2020 Jan 31]. Available from: https://www.ambu.com/endoscopy/monitors/ product/ambu-aview-2-advance
23. Canales BK, Gleason JM, Hicks N, Monga M. An independent analysis of flexible cystoscope repairs and cost. J Urol. 2007;178(5):2098–101; discussion 2102. http://dx.doi.org/10.1016/j.juro.2007.07.014
24. Fuselier HA, Mason C. Liquid sterilization versus high level disinfection in the urologic office. Urology. 1997;50(3):337–40. http://dx.doi.org/10.1016/ S0090-4295(97)00218-5
25. McGill JJ, Schaeffer AJ, Gonzalez CM. Durability of flexible cystoscopes in the outpatient setting. Urology. 2013;81(5):932–7. http://dx.doi.org/10.1016/j. urology.2013.01.029
26. Rutala WA, Weber DJ. Reprocessing semicritical items: Current issues and new technologies. Am J Infect Control. 2016;44(5 Suppl):e53–62. http://dx.doi. org/10.1016/j.ajic.2015.12.029
27. Noronha AM, Brozak S. A 21st century nosoco-mial issue with endoscopes. BMJ. 2014;348(mar19 8):g2047–g2047. http://dx.doi.org/10.1136/bmj.g2047
28. Chang C-L, Su L-H, Lu C-M, Tai F-T, Huang Y-C, Chang K-K. Outbreak of ertapenem-resistant Enterobacter cloacae urinary tract infections due to a contaminated ureteroscope. J Hosp Infect. 2013;85(2):118–24. http:// dx.doi.org/10.1016/j.jhin.2013.06.010
29. Koo VSW, O’Neill P, Elves A. Multidrug-resistant NDM-1 Klebsiella outbreak and infection control in endoscopic urology. BJU Int. 2012;110(11 Pt C):E922–6. http://dx.doi.org/10.1111/j.1464-410X.2012.11556.x
30. Wendelboe AM, Baumbach J, Blossom DB, Frank P, Srinivasan A, Sewell CM. Outbreak of cystoscopy related infections with Pseudomonas aeruginosa: New Mexico, 2007. J Urol. 2008;180(2):588–92. http:// dx.doi.org/10.1016/j.juro.2008.04.003
31. Moore B, Forman A. An outbreak of urinary Pseu-domonas aeruginosa infection acquired during urological operations. Lancet. 1966;2(7470):929–31. http:// dx.doi.org/10.1016/S0140-6736(66)90535-6
32. Jimeno A, Alcalde MM, Ortiz M, Rodríguez A, Al-caraz B, Vera F. Outbreak of urinary tract infections by Salmonella spp. after cystoscopic manipulation. Actas Uroló Esp (English Edn). 2016;40(10):646–9. http://dx.doi.org/10.1016/j.acuro.2016.02.005
33. Lamas Ferreiro JL, Álvarez Otero J, González González L, Novoa Lamazares L, Arca Blanco A, Bermúdez Sanjurjo JR, et al. Pseudomonas aeruginosa urinary tract infections in hospitalized patients: Mortality and prognostic factors. PLoS One. 2017;12(5):e0178178. http://dx.doi.org/10.1371/journal.pone.0178178
34. OYong K, Coelho L, Bancroft E, Terashita D. Health care-associated infection outbreak investigations in out-patient settings, Los Angeles County, California, USA, 2000–2012. Emerg Infect Dis. 2015;21(8):1317–21. http://dx.doi.org/10.3201/eid2108.141251
35. Echols RM, Palmer DL, King RM, Long GW. Multidrug-resistant Serratia marcescens bacteriuria related to urologic instrumentation. South Med J. 1984;77(2):173–7. http://dx.doi.org/10.1097/00007611-198402000-00010
36. Climo MW, Pastor A, Wong ES. An outbreak of Pseudomonas aeruginosa related to contaminated urodynamic equipment. Infect Control Hosp Epidemiol. 1997;18(7):509–10. http://dx.doi.org/10.2307/30141192
37. British Association of Urological Surgeons (BAUS). Flexible Cystoscopy [Internet]. Available from: https:// www.baus.org.uk/_userfiles/pages/files/Patients/Leaf-lets/Flexible%20cystoscopy.pdf
38. Herr HW. Should antibiotics be given prior to outpatient cystoscopy? A plea to urologists to practice antibiotic stewardship. Eur Urol. 2014;65(4):839–42. http:// dx.doi.org/10.1016/j.eururo.2013.08.054
39. Herr HW. The risk of urinary tract infection after flexible cystoscopy in patients with bladder tumor who did not receive prophylactic antibiotics. J Urol. 2015;193(2):548–51. http://dx.doi.org/10.1016/j. juro.2014.07.015
40. Baston EL, Wellum S, Bredow Z, Storey G, Palmer A, Dellen DV, et al. Office-based ureteric stent removal is achievable, improves clinical flexibility and quality of care, whilst also keeping surgeons close to their patients. Cent European J Urol. 2018;71(2):196–201.
41. Maurice JB, Siau K, Sebastian S, Ahuja N, Wesley E, Stableforth W, et al. Green endoscopy: A call for sustainability in the midst of COVID-19. Lancet Gastroenterol Hepatol. 2020;5(7):636–8. http://dx.doi. org/10.1016/S2468-1253(20)30157-6
42. Pichler P-P, Jaccard IS, Weisz U, Weisz H. Interna-tional comparison of health care carbon footprints. Environ Res Lett. 2019;14(6):064004. http://dx.doi. org/10.1088/1748-9326/ab19e1
43. Vaccari M, Tudor T, Perteghella A. Costs associated with the management of waste from healthcare
facilities: An analysis at national and site level. Waste Manag Res. 2018;36(1):39–47. http://dx.doi. org/10.1177/0734242X17739968
44. Davis NF, McGrath S, Quinlan M, Jack G, Lawrents-chuk N, Bolton DM. Carbon footprint in flexible ureteroscopy: A comparative study on the environmental impact of reusable and single-use ureteroscopes. J Endourol. 2018;32(3):214–17. http://dx.doi.org/10.1089/ end.2018.0001
45. Lilholt Sørensen B, Grüttner H. Comparative study on environmental impacts of reusable and single-use bronchoscopes. AJEP. 2018;7(4):55. http://dx.doi. org/10.11648/j.ajep.20180704.11
46. Ambu. Sustainability report 2019/20 [Internet]. [cited 2021 Feb 16]. Available from: file:///C:/Users/Anton.Wong/ Desktop/AMBU/Sustainability_Report_2019_20.pdf