Worldwide variations in purchase and per-procedure costs of single-use flexible ureteroscopes and flexible navigable access sheaths: the economic impact of reuse strategies on procedural outcomes from a 40-country YAU-EAU endourology international collaboration.

Endourological practice increasingly relies on single-use devices, the costs of which vary considerably across regions and healthcare systems. Flexible single-use ureteroscopes (FURS) and flexible and navigable suction ureteral access sheaths (FANS) represent a substantial proportion of ureteroscopy-related expenditure. To mitigate these costs, some centres have adopted reuse strategies aimed at reducing per-procedure expenses. The aim of this study was to evaluate international variation in the purchase prices and real-world per-procedure costs of FURS and FANS, and to assess the economic impact of device reuse strategies. An international collaborative study coordinated by the Young Academic Urologists (YAU) and European Association of Urology (EAU) Endourology Groups was conducted across 40 countries. Endourologists provided real-world procurement data regarding purchase prices, utilization patterns, and equipment-related procedural cost of single-use FURS and FANS between March 2025 and January 2026. All costs were converted to Euros (€). In centres adopting institution-validated reuse protocols, weighted per-procedure costs were calculated by dividing device acquisition costs by the number of effective uses. Countries were stratified according to cost quartiles to assess global variability. Data were collected from 40 countries across Europe, Asia, North and South America, and the Middle East. The median purchase cost of single-use FURS was €676.7 (IQR €579.0-975.0), ranging from €310 in Romania to €1638 in Cyprus. When adjusted for reuse practices, the median equipment-related procedural cost decreased to €425.0 (IQR €216.4-611.2), with values ranging from €92 in Brazil to €1343 in Ireland. The median purchase cost of FANS was €180 (IQR €130-226), ranging from €36 in Uzbekistan to €400 in the United States. Weighted per-procedure costs decreased to a median of €130.5 (IQR €77.5-182.2). The combined equipment cost of FURS and FANS for suction-assisted ureteroscopy ranged from €139.2 in Uzbekistan to €1691 in the United States (USA). Countries adopting cost-conscious reuse strategies achieved substantial reductions in per-procedure expenditure despite high initial acquisition costs. Marked international variability exists in the procurement and equipment-related procedural cost of FURS and FANS, with up to fourfold differences observed between countries. Reuse strategies substantially reduce equipment-related expenditure and may improve the economic sustainability of ureteroscopy. These findings highlight the importance of considering regional cost structures and resource utilization when evaluating the value of emerging endourological technologies.