title: Ureteral stenting and retrograde pyelography in the office: clinical outcomes, cost effectiveness, and time savings.
abstract: OBJECTIVE
  To examine the clinical outcomes and cost-effectiveness of endourologic procedures performed in the office using standard fluoroscopy and topical anesthesia.
  
  
  METHODS
  We performed a retrospective review of all patients who underwent primary ureteral stent placement, ureteral stent exchange, or ureteral catheterization with retrograde pyeolography or Bacillus Calmette-Guerin (BCG) instillation under fluoroscopic guidance in the office. For an evaluation of potential time savings, we compared this to a cohort of similar procedures performed in the operating room during the same time period.
  
  
  RESULTS
  Procedures were attempted in 65 renal units in 38 patients (13 male, 25 female) with a mean age of 62.2 years (range 29.1-95.4 years). Primary ureteral stent placement was successful in 23/24 (95.8%) renal units. Ureteral stent exchange was successful in 19/22 (86.4%) renal units. Ureteral catheterization with retrograde pyelography or BCG instillation was successful in 19/19 (100%) renal units. The total cost savings for the 38 patients in this study, including excess cost from failure in the office, was approximately $91,496, with an average cost savings of $1,551 per procedure. Office-based procedures were associated with a nearly three-fold reduction in total hospital time as a result of reduced periprocedure waiting times.
  
  
  CONCLUSIONS
  Ureteral stent placement, ureteral stent exchange, and ureteral catheterization can be performed safely and effectively in the office in both men and women. This avoids general anesthesia and provides significant savings of time and cost for both patients and the health care system.
authors: Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
authors: Boris
authors: B
authors: Gershman
authors: Brian H
authors: BH
authors: Eisner
authors: Sonali
authors: S
authors: Sheth
authors: Dianne E
authors: DE
authors: Sacco
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D012189:Retrospective Studies; D015607:Stents / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014515:Ureteral Diseases / Q000000981:diagnostic imaging* / Q000191:economics / Q000601:surgery*; D014567:Urography / Q000191:economics / Q000379:methods