Preoperative Stent Placement Decreases Cost of Ureteroscopy

ObjectivesTo examine the effect of preoperative stent placement on total cost of ureteroscopic stone intervention. Passive ureteral dilation with a preoperative ureteral stent has been proposed as a method to facilitate both upper tract access and stone removal.MethodsWe retrospectively reviewed the records of patients who underwent ureteroscopic stone intervention at our institution from 2005 to 2009. A sample of patients who had undergone stenting before ureteroscopy was selected and nonstented matched controls were used as a comparison group. A cost model was used to compare the total healthcare costs for the prestented and nonstented patients with a large (>1 cm) and small (≤1 cm) stone burden using the actual cost accrued for each patient. Sensitivity analyses were used to examine the robustness of the cost model.ResultsA total of 104 patients were included in the present study (45 prestented, 59 not prestented). The median stone size was 1 cm (range 0.3-4). The overall stone clearance rate was 95.8%. The median number of procedures was 1. Pre-stenting significantly decreased the total healthcare cost in patients with stones >1 cm. The median cost for the prestented and nonstented cohorts was $17 706 and $27 806, respectively (P < .01). However, prestenting increased the total cost for smaller stones of ≤1 cm, although not significantly. The median cost for the prestented and nonstented cohorts was $10 872 and $12 344, respectively (P = .70). Sensitivity analysis confirmed that the model conclusions are robust.ConclusionsPreoperative stent placement is cost-effective for successful ureteroscopic treatment of stones >1 cm.