title: Preoperative stent placement decreases cost of ureteroscopy.
abstract: 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.
authors.affiliation: Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-3232, USA. chul@upmc.edu
authors.forename: Lei
authors.initials: L
authors.lastname: Chu
authors.forename: Coreen A
authors.initials: CA
authors.lastname: Farris
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Corcoran
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Averch
mesh_terms: D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000191:economics* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015607:Stents; D014514:Ureteral Calculi / Q000191:economics* / Q000601:surgery*; D018666:Ureteroscopy / Q000191:economics*