In May, Charles Nottingham, MD, MS, an Assistant Professor of Surgery in the Division of Urology, performed the first ureteroscopy with the Dornier AXIS Single-Use Digital Ureteroscope at Barnes-Jewish St. Peters Hospital.
Washington University urologists at Barnes-Jewish St. Peter’s Hospital and Progress West Hospital have started a new hybrid system of single-use and reusable digital ureteroscopes for patients requiring this operation. With this new system, urologic surgeons at these locations hope to advance these procedures by lowering hospital costs, ensuring patient satisfaction and improving overall visual quality for better treatment of the stones.
A ureteroscopy is a very common procedure for patients with kidney stones who need surgical treatment. The urologic surgeon inserts a ureteroscope, which is a small, flexible telescope, through the urethra and bladder and up the ureter to locate the stone and remove it.
When a patient has stones that are far up in the kidney, surgeons need to use a special type of ureteroscope called a flexible ureteroscope. For many years, the only flexible ureteroscopes available were reusable, but in recent years, companies developed disposable, single-use scopes. Urologic surgeons saw a need for these disposable ureteroscopes because the reusable scopes must be repaired frequently.
“Oftentimes during these cases, the scopes get a lot of wear and tear and they have to be repaired,” Nottingham explains. “The national reported rates are anywhere between 10 to 20 cases that you get out of a reusable scope before you have to send it off for repair, and on average those repairs are anywhere from the $6,000 to $8,000 range, so it’s a pretty big expense to repair them.”
Integrating disposable ureteroscopes could thus be more cost-effective for hospitals, compared to only using reusable ones. Washington University urologic surgeons have started a program where the surgeon looks at a patient case to assess if it meets criteria for needing a disposable scope, as there are some predictors well reported in literature that cause the scope to have to be repaired. If so, then they will use a single-use scope instead.
“If there are some cases that we know are more likely to cause a lot of wear and tear or break the scope, causing it to require repair, those are good cases for saying let’s use a single-use scope that only costs $800 to $1,200,” states Nottingham. “We should preferably use these scopes to try to cut down health care system costs, which can be substantial.”
With the ureteroscopy cases at Barnes-Jewish St. Peter’s Hospital and Progress West Hospital on the rise, Nottingham also saw that starting a hybrid system like this could lead to less wait time for patients undergoing the procedure.
“At Barnes-Jewish St. Peter’s and Progress West, we only have two reusable scopes per hospital, and these scopes must get repaired a lot. Let’s say one’s out for repair and I’ve got three ureteroscopies on for the day. That creates a real problem because you have to wait for the scope to get sterilized in between cases,” he explains. “If you can just pull a disposable scope off the shelf and keep things going, that really helps with patient satisfaction.”
In addition to cutting costs, the new reusable and single-use digital ureteroscopes a part of the hybrid system have better visual quality for surgeons performing the procedure. “Our new ureteroscopes for the hybrid system are all digital so the vision is great, which means the surgeon can more reliably ensure we have removed all of the stones since we can see better,” Nottingham states.
Going forward, Nottingham and the Washington University urologists using this new hybrid system hope to further refine the criteria for who is going to benefit from it and how they can save on hospital costs.
“We have the information from however this will pan out in terms of our cost effectiveness for a hospital that a lot of hospitals really would want to know,” he states.
Washington University urologists can compare Barnes-Jewish Hospital’s ureteroscope system, which has a reusable scope repair contract, to the new hybrid model to determine which is more efficient.
“That would be something that we would ideally like to use the data we have to create some publication, at least one if not more publications from it.”
Nottingham performs a high volume of ureteroscopy cases out of the Urology faculty, as he focuses on kidney stone disease and diseases of enlarged prostate. He particularly likes working at Washington University because he can focus on those areas of interest and refer any patients with other urological conditions to fellow faculty who are also experts in their fields. Nottingham joined the Division of Urology last year and sees patients most frequently at Barnes-Jewish West County Hospital and Barnes-Jewish St. Peter’s Hospital.
To request an appointment with Dr. Nottingham, please call (314) 362-8200.