Primary antegrade ureteric stenting: prospective experience and cost-effectiveness analysis in 50 ureters.
OBJECTIVE
To evaluate the success rate and cost efficiency of primary antegrade ureteric stenting (antegrade ureteric stent insertion as a single procedure without preliminary drainage).


METHODS
A policy of primary stenting was tested in 38 patients (50 ureters) with obstructive hydronephrosis, of acute or chronic onset and of benign or malignant origin. Patients with suspected pyonephrosis were excluded. Patients successfully primarily stented (group 1) were compared to a group stented as a traditional two-stage procedure (group 2). End point assessments were screening time, equipment used, procedure-related costs, bed occupancy and technical and clinical success rate. Using these cost and outcome measures, a cost-efficiency analysis was performed comparing the two strategies.


RESULTS
40/50 (80%) ureters were considered primary stent successes. The average procedure-related bed occupancy was 2 days (range 1-2 days). Simple equipment alone was successful in 16 cases. Van ( pound46/case). The mean screening time was similar for the two groups (13.5 min vs Andel dilatation catheters and peel-away sheaths were frequently used (23 ureters). Expensive equipment was rarely necessary (four cases) and average extra equipment cost was small 15.3 min; P > or = 0.05). There was a minimum saving of pound800 per successful primary stent. The cost-effectiveness of a primary antegrade stenting strategy was pound1229 vs pound2093 for secondary stenting.


CONCLUSIONS
In carefully selected patients, the majority of obstructed ureters can be primarily stented using simple equipment. The reduced hospital stay and overall success rate significantly improves the cost competitiveness of antegrade ureteric stenting.
Watson
G M
GM
Department of Radiology, St George's Hospital and Medical School, London, UK.
Patel
U
U
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002404:Catheterization / Q000191:economics / Q000379:methods*; D002908:Chronic Disease; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000191:economics / Q000209:etiology / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000191:economics; D011446:Prospective Studies; D012086:Reoperation / Q000191:economics; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014546:Urinary Catheterization