Presented by: Andreia Cardoso MD
Urology Department, Hospital de Braga, Portugal

Introduction

Urolithiasis is a major health problem worldwide, affecting adult patients, with high socioeconomic burden. It is a major motif for urgent admission in urologic departments, and it can present complications requiring urgent urinary decompression. Double-J ureteral stents (JJ) or percutaneous nephrostomy (PN) placement are the most frequently used methods, while ureteroscopy (URS) is usually reserved for urolithiasis’ elective treatment, though it can be performed in selected urgent cases. Thus, our goal was to compare the economic costs of these treatments, in the setting of urgent management of obstructive urolithiasis.

Materials

Retrospectively, we divided patients submitted to urgent treatment of obstructive urolithiasis in our department, from January 2019 to December 2021, in 3 groups, according to the decompressing treatment applied: JJ, PN or URS.

We collected baseline demographic and clinical data, and analyzed hospital costs from the 1^st urgent intervention, until the 1^st attempt of definitive urolithiasis’ surgical treatment. Cost analysis included: hospital readmissions, imaging and laboratorial exams performed, type of initial and definitive interventions.

Results

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A total of 349 patients were included. JJ was the preferred option for 1^st intervention (JJ n=281; PN n=23; URS n=45). Infection was the main reason for PN placement, while for URS it was refractory pain. The mean length of the 1^st hospital stay was: 4.2 (JJ) vs 6 (PN) vs 2.8 (URS) days. Emergency department readmissions were: 33.45% (JJ) vs 56.52% (PN); and for hospital stay: 6.05% (JJ) vs 34.78% (PN). However, the mean length of hospital readmissions was: 10 (JJ) vs 4.2 days (PN). There were some differences on the definitive urolithiasis treatment between groups. Table 1 presents results’ details.

Estimated overall cost was: 7 140.82€ for URS, 14 422.45€ for JJ, and 15 430.54€ for PN.

Conclusion

URS seams the most cost-effective decompressing method in the setting of obstructive urolithiasis. However, we recognize it requires ideal conditions not always present in emergency departments (material, time), as well as patients’ selection (not for sepsis or high stone burden cases). Socioeconomic burden and patient-related outcomes were not evaluated but it will possibly reinforce the benefits of URS. Despite suggesting more quality studies, we stress out the benefit of URS for urgent decompression and definitive treatment of obstructive urolithiasis.

Funding

None.

Co-Authors

Andreia Cardoso, MD
Urology Department, Hospital de Braga, Portugal

Eliana Pereira,
School of Medicine, University of Minho, Braga, Portugal

Ricardo Matos Rodrigues, MD
Urology Department, Hospital de Braga, Portugal

Catarina Laranjo Tinoco,
Urology Department, Hospital de Braga, Portugal

Ana Sofia Araújo, MD
Urology Department, Hospital de Braga, Portugal

Mariana Dias Capinha, MD
Urology Department, Hospital de Braga, Portugal

Luís Pinto, MD
Urology Department, Hospital de Braga, Portugal

João Pimentel Torres, MD
Urology Department, Hospital de Braga, Portugal

Paulo Mota, MD
Urology Department, Hospital de Braga, Portugal