Evaluation of perioperative outcomes associated with the flexible ureterorenoscopy with flexible and navigable suction ureteral access sheath and reused disposable scopes: a prospective multicentre study by the European Association of Urology and European Association of Urology Section of Endourology

Background: With the increasing adoption of single-use ureteroscopes in retrograde intrarenal surgery (RIRS), concerns regarding cost and environmental sustainability have prompted interest in their reuse, giving rise to the concept of reused disposable scopes (RDS). This study evaluates the impact of RDS on perioperative outcomes in RIRS when used in conjunction with novel technologies such as the flexible and navigable suction access sheath (FANS). Methods: This prospective multicenter study included 607 adult patients undergoing RIRS with RDS across 12 international centers between July 2025 and March 2026. The primary outcomes were stone-free rate (SFR) and perioperative complications. Subgroup analyses were performed based on the number of prior uses and cumulative duration of prior ureteroscope use. Results: The median operative time was 60 min, and intraoperative scope failure occurred in 15.0% of cases. The 30-day SFR (Grade A) was 87.5%. Increasing reuse was associated with longer operative times (p < 0.0001) and higher rates of intraoperative scope replacement (6.7% for more than 1 reuse vs. 39.9% for ≥ 4 reuses; p < 0.0001). Similarly, greater cumulative usage duration significantly impacted operative efficiency and failure rates. While postoperative infectious complications and readmissions remained comparable across subgroups, differences in residual fragment rates and SFR distribution were observed between reuse categories. Conclusions: RIRS using FANS is clinically feasible in real-world settings, particularly in centers with appropriate infrastructure and expertise in reprocessing disposable flexible ureteroscopes. Both increasing reuse cycles and prolonged cumulative device usage were associated with progressive technical deterioration, including higher malfunction and intraoperative replacement rates. Re-sterilization beyond 90 min is discouraged.