Presented by: Reut Shashar MD
Rambam Medical Center

Introduction

Ureteroscopy (URS) for treating stone disease involves the cost of the procedure, as well as additional costs involving the perioperative period, hospitalization, and expenses due to common complications. Real-life expenses for achieving stone-free status involves the cost of URS, hospitalization days, insertion and removal of ureteral stents, and extra costs for possible complications such as emergency room (ER) visits and additional procedures.

Primary URS compared to post-stent URS are both accepted treatments for renal and ureteral calculi, without any proven clinical superiority of one over the other. In this study we compared the cost of the two options in a public healthcare system, incorporating real-life expenses and clinical outcomes.

Materials

Clinical data regarding patients treated for ureter and kidney stones were collected retrospectively: demographic details, stone characteristics, information regarding ER visits, hospital admissions, and treatment in the pre and post-operative period. Total treatment cost was calculated by summing the cost of URS (5,896$), stent insertion (892$) and removal (1,652$), need for additional ureteroscopies, ER visits (262$), and hospitalization stay (952$ per day) in the perioperative period (30 days post OP). A statistical analysis was made to compare both treatment options.

Results

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299 patients underwent URS between 2019-2022, 145 had primary URS and 154 had URS following prior stenting. Age and sex did not differ among groups. Stone size was larger in the pre-stented group: 9 mm (IQR [6-15mm]) vs 7 mm (IQR [5-10mm], p=0.019. In the pre-stented group, 70% (108/154) had a proximal stone (kidney or upper ureter), and 30% (46/154) had a distal stone (middle or distal ureter), compared to 54% (79/145) proximal stone, and 46% (66/145) in the non-stented group. The mean cost of the treatment was lower for proximal stones in 1,176$, comparing to the pre-stented group (8,807 USD vs 9,983 USD, p-value = 0.035). In distal stones, there was no significant difference in the overall cost between pre-stented and non-stented patients, regardless of stone size. The overall stone-free rate after 3 months was similar in both groups (87% vs 86%, respectively).

Conclusion

Stenting before ureteroscopy for renal and upper ureteral stones may lower the overall cost of the treatment with a similar stone-free rate.

Funding

N/A

Co-Authors

Lihi Blumen,
Rambam Medical Center

Boris Lebedenko,
Rambam Medical Center

Michael Mullerad, MD
Rambam Medical Center

Oleg Goldin, MD
Rambam Medical Center

Gilad Amiel, Prof.
Rambam Medical Center

Azik Hoffman, MD
Rambam Medical Center