Faculty Bibliography

OBJECTIVES/OBJECTIVE:To 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. METHODS:We 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. RESULTS:A 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. CONCLUSIONS:Preoperative stent placement is cost-effective for successful ureteroscopic treatment of stones >1 cm.