title: Ureteral access sheath use and stenting in ureteroscopy: effect on unplanned emergency room visits and cost.
abstract: OBJECTIVE
  We studied the impact of stented and unstented ureteroscopy on unplanned emergency room (ER) return visits, medical costs, and whether use of a ureteral access sheath precluded uncomplicated ureteroscopy.
  
  
  METHODS
  A series of 161 consecutive patients undergoing ureteroscopy for renal or ureteral stones was evaluated retrospectively. We examined sex, age, stone size, stone location, use of a ureteral access sheath, use of a ureteral stent, unplanned ER visits, unplanned imaging, and interventions. Medical costs were calculated according to British Columbia Medical Services Plan rates.
  
  
  RESULTS
  In the 107 stented and 54 unstented patients, the mean stone sizes were 9 and 7 mm, respectively (P = 0.01), and ureteral access sheaths were used in 55% and 35% (P = 0.002). Stent use did not differ by patient age or sex or stone location. The ER return rates were 17% v 22% for the stented and unstented patients, respectively (P = 0.40), with emergency CT scans being performed in 28% v 75% of the returning patients (P = 0.02), hospital readmission in 22% v 58% (P = 0.05), and urgent decompression in 0 v 25% (P = 0.04). Among patients who were not stented, 37% of those treated using ureteral access sheaths v 14% treated without access sheaths returned to the ER (P = 0.04). The median costs were CDN dollars 1212 for stented and CDN dollars1071 for unstented patients (P < 0.0001).
  
  
  CONCLUSIONS
  The unplanned ER return rate is similar whether patients are stented or unstented after ureteroscopy. The median cost saving for unstented patients is approximately CDN dollars140. Use of a ureteral access sheath precludes uncomplicated ureteroscopy, and a ureteral stent should be placed in these cases.
authors.affiliation: Division of Urology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rapoport
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Perks
authors.forename: Joel M H
authors.initials: JM
authors.lastname: Teichman
mesh_terms: D000328:Adult; D002170:Canada; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D014513:Ureter / Q000473:pathology; D014514:Ureteral Calculi / Q000378:metabolism*; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000379:methods*