{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T22:45:39Z","timestamp":1773355539533,"version":"3.50.1"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the associations between how reusable flexible cystoscopes (FCs) are managed during their functioning lifetime and their longevity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>This was an exploratory retrospective analysis of administrative data collected by a medical supplies company (KARL STORZ Endoscopy (UK) Ltd) on FC usage linked at a National Health Service (NHS) hospital trust level to data from NHS England's Hospital Episodes Statistics dataset on the number of FCs performed each year in the NHS in England. Number of uses before failure (defined as user\u2010determined need for FC return to the supplier) were analysed descriptively and using a negative binomial regression model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Data were available for 1918 FCs across 70 hospitals. The median (interquartile range) number of uses and min of use before failure were 58 (20\u2013147.75) and 706.5 (208.25\u20131718), respectively. Eighty\u2010five percent of returned FCs were exchanged (i.e. replaced with a new FC), at a median of 66 uses. The two most common reasons for failure \u2013 damage to the working channel and control handle housing \u2013 were observed in 76.3% and 63.8% of returned FCs, respectively. A greater number of uses before failure was significantly associated with recency, same\u2010site same\u2010complex decontamination, on\u2010site endoscopic specialist availability, decontamination in a general endoscopy unit, and drying cabinet or bowl storage rather than vacuum packaging. Top\u2010quintile\u2010volume units were associated with a significantly higher number of uses before failure, however, there was otherwise no clear independent volume\u2013longevity association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This exploratory analysis generates mechanistically plausible hypotheses regarding factors that could promote FC longevity. These findings are of relevance as we seek to understand how to optimise the cost, resilience and environmental sustainability of healthcare. A prospectively designed study could investigate whether there is a causal link between the key factors identified and longevity of FC usage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70133","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T03:29:16Z","timestamp":1766546956000},"page":"509-518","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with flexible cystoscope longevity: an analysis of supplier and health service datasets"],"prefix":"10.1111","volume":"137","author":[{"given":"Joseph B.","family":"John","sequence":"first","affiliation":[{"name":"University of Exeter Medical School University of Exeter  Exeter UK"},{"name":"Department of Urology Royal Devon University Healthcare NHS Foundation Trust  Exeter UK"},{"name":"Getting It Right First Time Programme NHS England  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Feasey","sequence":"additional","affiliation":[{"name":"KARL STORZ Endoscopy (UK) Ltd  Slough UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ranan","family":"Dasgupta","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim W.R.","family":"Briggs","sequence":"additional","affiliation":[{"name":"Getting It Right First Time Programme NHS England  London UK"},{"name":"Royal National Orthopaedic Hospital, Stanmore  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John S.","family":"McGrath","sequence":"additional","affiliation":[{"name":"Getting It Right First Time Programme NHS England  London UK"},{"name":"Urology Department North Bristol NHS Foundation Trust  Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9597-5446","authenticated-orcid":false,"given":"William K.","family":"Gray","sequence":"additional","affiliation":[{"name":"Getting It Right First Time Programme NHS England  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"1","article-title":"The global epidemiology of bladder cancer: a joinpoint regression analysis of its incidence and mortality trends and projection","volume":"8","author":"Wong MCS","year":"2018","journal-title":"Sci Rep"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2024.07.027"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/bco2.70052"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.4103\/0970-1591.109975"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euo.2024.08.001"},{"key":"e_1_2_11_7_1","volume-title":"GIRFT Greener Pathways: a Practical Guide to Decarbonising the Bladder Cancer Care Pathway","author":"NHS England","year":"2024"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.15949"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1089\/end.2021.0891"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euf.2022.12.006"},{"key":"e_1_2_11_11_1","article-title":"Are single\u2010use flexible cystoscopes environmentally sustainable? 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