Physical properties of flexible ureteroscopes: Implications for clinical practice

Background and Purpose: Physical characteristics may be important in the performance of a flexible ureteroscope. This study evaluated the strength of the shaft and deflection mechanism of several instruments. Materials and Methods: Sequential loads were placed along the axis of downward deflection to measure the stiffness of the shaft and strength of deflection. Bending pressure was defined as the force required to deflect the tip of the ureteroscope 15° from baseline. Buckling pressure was defined as the force that resulted in catastrophic bending (>90°) of the shaft of the ureteroscope. Strength of deflection was defined as the force that resulted in loss of 10° of active deflection. Results: Bending pressures were lower for the Olympus URF-P3 (6.4 g) and Wolf 7325.172 (6.0 g) ureteroscopes. Similarly, buckling pressures were lower for these two ureteroscopes (9.0 g and 11.6 g, respectively). The Wolf and Storz flexible ureteroscopes had stronger deflection mechanisms than the Olympus URF-P3 and the ACMI DUR-8. Conclusions: This study demonstrates significant differences in ureteroscope strength. Higher buckling pressures may facilitate advancement of a ureteroscope over a guidewire but may impede secondary deflection. Lower bending pressures may facilitate passive intrarenal manipulation. Strength of deflection may impact the ability to maintain deflection with an instrument in the working channel.