Identifying a break in the chain: An analysis of where ureteroscope damage occurs in the hospital cycle.

OBJECTIVE: To assess the timing and variables associated with damage to fURS at our institution. Flexible ureteroscopy is an important modality in the treatment of benign and malignant conditions of the upper urinary tract. While the durability and versatility of flexible ureteroscopes (fURS) have improved considerably, repair costs remain high and time out of commission diminishes work flow. After purchasing new digital fURS, we studied how and when these instruments were being damaged. METHODS: Between Sept. 1, 2017 and Jun. 30, 2018 we performed leak testing on fURS both before and after use. We gathered intraoperative data related to the user, the surgical indication, and the associated tools used in all cases that employed a digital or fiber optic fURS. Categorical and continuous variables were analyzed to identify risk factors for intraoperative fURS damage. RESULTS: During the study period, complete data was gathered for 281 cases. Twenty-two fURS failed leak testing indicating an overall leak failure rate of 7.8%. Of these, 15 failed leak testing preoperatively indicating non-operative damage occurring sometime during transport, handling, or sterile processing. The other 7 failures occurred during the procedures. No intraoperative variables were significantly associated with failures. CONCLUSIONS: Our institutional leak failure rate is 8% (22/281). The majority of these failures did not occur during surgery. Of the seven that occurred during surgery, larger stone burden and higher wattage showed mild association. Ongoing evaluation will target minimizing fURS damage outside of the operating room.