Journal of Pediatric Urology (2015) 11, 164

Letter to the Editor

Flexible ureteroscopy and lasertripsy (FURSL) for paediatric renal calculi: Results from a systematic review We thank the authors for their interest in our study [1] and agreeing with us about the safety of ureteroscopy as a first-line treatment option in most paediatric stone cases. We agree with them that the cost of flexible ureteroscope (FURS), along with its maintenance and repair, can be a major factor in determining the treatment modality. To this effect, we looked at the cost of performing a flexible ureteroscopy procedure, taking into account the cost of ancillary equipment and scope repairs over a one-year period [2]. Based on our model, the cost of performing a diagnostic FURS was £131 (equivalent to V157 or $196.50) and FURS and lasertripsy for stones was between £296 and £429 (V355-515 or $444-644) [2]. Recently, when we compared our initial data from 2009 to more recent data from 2012, a significant reduction in scope damage was achieved by using disposable laser fibres, leading to halving of the scope repair cost [2,3]. Using a protocol of ureteric mapping with a semi-rigid ureteroscope prior to FURS, use of an access sheath, where possible, and repositioning of lower pole stones, we achieved an average use of 89 cases per scope [4]. The cost of FURS is also dependent on the volume of cases that are performed, and competitive business contracts can help to bring the cost down. Durability and quality of ancillary equipment, along with trained endoscopy staff and negotiated warranty for repairs, can help decrease the number and cost of repairs. As more scope damage seem to happen with refurbished FURS, our model of replacing the

broken scope with a new scope may prove to be more viable in the long run [2,5]. With better endoscopy and surgeon training, combined with competitive procurement and maintenance of equipment, ureteroscopy can be offered to the majority of patients without the need to restrict it based on cost.

References [1] Ishii H, Griffin S, Somani BK. Flexible ureteroscopy and lasertripsy (FURSL) for paediatric renal calculi: results from a systematic review. J Pediatr Urol 2014;10(6):1020e5. [2] Chapman RA, Somani BK, Robertson A, Healy S, Kata SG. Decreasing cost of flexible ureterorenoscopy: single-use laser fiber cost analysis. Urology 2014;83(5):1003e5. [3] Somani BK, Robertson A, Kata SG. Decreasing cost of flexible ureterorenoscopic procedures: cost volume relationship. Urology 2011;78(3): 528e30. [4] Ishii H, Drake T, Somani BK. Preventing flexible ureterorenoscope damage: how we did it. J Endourology 2013;A411. MP28e26. [5] Carey RI, Martin CJ, Knego JR. Prospective evaluation of refurbished flexible ureteroscope durability seen in a large public tertiary care center with multiple surgeons. Urology 2014; 84(1):42e5.

Bhaskar K. Somani* Consultant Urological Surgeon (Endourology Lead), University Hospitals Southampton NHS Trust, Southampton SO16 6YD, United Kingdom *Tel.: þ44 (0) 2381205272. E-mail address: [email protected] 15 January 2015 Available online 17 March 2015

DOI of original article: 1477-5131/ª 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Flexible ureteroscopy and lasertripsy (FURSL) for paediatric renal calculi: Results from a systematic review.

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