Background:
Flexible cystoscope instrumentation continues to evolve. We compared irrigant flow rates, deflection angles, and optical characteristics of several commercially available digital and fiberoptic cystoscopes.
Methods:
This evaluation included the ACMI ACN2, ACMI ICN digital scope, Karl Storz 11272CU1, Olympus Endo Eye Digital scope and Pentax FCY-15P2, flexible cystoscopes. Parameters measured included: irrigant flow rates, deflection angles, and optical characteristics. Irrigant flow rates and deflection angles were evaluated for each cystoscope in the straight and deflected positions with the working channel empty or with various accessories including a stent grasper, 0.035'' PTFE guidewire, and 5F ureteral catheter. Each evaluation was performed in triplicate. Optical characteristics were measured by the ability to read printed material of a size 8 font through 100cc of water to which varying amounts of red food dye had been added.
Results:
Irrigation flow and degree of deflection were affected by an occupied working channel. The guide wire caused the least amount of resistance, followed by the stent grasper and the 5F ureteral cathether, which caused the greatest reduction in flow and deflection. The Storz cystoscope had the fastest irrigant flow rate, regardless of whether the working channel was empty and was comparable to the other cystoscopes with respect to degree of deflection and visibility. The ACMI ACN2 and ICN had the slowest irrigant flow rate (both at 3.33 ml/s), followed by the Pentax at 3.57 ml/s and the Olympus at 3.76 ml/s. With respect to optical characteristics, the Pentax had poorer visibility compared to the other 4 cystoscopes, which were comparable to one another. With regards to deflection, the Pentax had the greatest deflection (213^o) in the up direction, but the ACN2 had overall superior deflection (190^o up /170.5^o down) compared to the other cystoscopes.
Conclusions:
The cystoscopes available at our centre differ with respect to irrigant flow rates and deflection angles, regardless of whether the working channel is occupied or empty. The Storz 11272CU1 cystoscope had superior flow rates compared to other cystoscopes. The ACMI ACN2 had the best overall deflection. Commercially available cystoscopes differ in deflection and working channel size although optics are similar between fiberoptic and digital cystoscopes in a rudimentary test.

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