Global variation in acquisition costs of single-use flexible ureteroscopes and flexible navigable access sheaths: an international collaborative analysis from the YAU & EAU Endourology groups

Pietropaolo A.; Alhusseinawi H.; Soebhali B.; Cabrera J.; Tursunkulov A.; Ragoori D.; Vincentini F.C.; Astroza G.M.; Petkova K.; Yong C.S.; Davis N.; Netsch C.; Becker B.; Chai C.A.; Panthier F.; Ketsuwan C.; Durutovic O.; Solano C.; Gadzhiev N.; Bhojani N.; Gravas S.; Geavlete B.; Zribi A.S.; Kronenberg P.; Lifshitz D.; Jung H.; Gauhar V.; Yuen S.K.K.; Pauchard F.; Tsaturyan A.; Ventimiglia E.; Tzelves L.; Martinez B.B.; Ergül R.B.; Sener T.E.; Nowak Ł.; Tailly T.; Boeykens M.; Sierra A.; Talyshinskii A.; Keller E.X.; Esperto F.; Olivero A.; Mykoniatis I.; Jahrreiss V.; Juliebø-Jones P.; Hamri S.B.; Contreras P.; Alvarez J.; Frascheri M.F.; Somani B.K. · World Journal of Urology (2026) · DOI: 10.1007/s00345-026-06668-8

Resumen

Background and objective: Endourological practice increasingly depends on single-use devices, whose costs vary considerably across regions and health care systems. Flexible single use ureteroscopes (URS) and flexible and navigable sheaths (FANS) represent a major component of ureteroscopy-related expenditure. This study aimed to evaluate international variation in purchase and device-related acquisition cost of URS, FANS, and the cost of FANS (suction) assisted URS (URS and FANS). Methods: An international collaborative dataset compiled by the EAU Endourology Group collected information on device purchase prices for single use flexible ureteroscopes, FANS, and suction assisted URS across multiple countries. All costs were converted to Euros (€). Countries were stratified into quartiles, and global medians with interquartile ranges (IQRs) were reported. Results: Data were obtained from 40 countries across Europe, Asia, North and South America, and the Middle East, and showed a significant global cost variation. The median price of single-use FURS was €676.7 (IQR 579–975), ranging from €310 (Romania) to €1638 (Cyprus), while FANS cost €180 (IQR 130–226), ranging from €36 to €400. Median per-procedure FANS assisted URS cost was €951.6 (range €415–1881). Lowest costs were observed in Romania, Belgium, and Germany, while highest were in Cyprus, Russia, and the United States, with up to four-fold inter-country variation, including within Europe. Conclusions: Substantial global variability exists in the cost of URS and FANS, influenced by healthcare policy, and economic conditions. These findings highlight the need for cost-effectiveness analyses and the development of evidence-based procurement policies to promote sustainability and equitable access in endourological practice. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2026.