Ureteral stent removal using an extraction string after uncomplicated ureteroscopy: a cost-benefit analysis

Area of Science:

• Urology
• Medical Devices
• Health Economics

Background:

• Indwelling ureteral stents are commonly used after ureteroscopy (URS) for kidney stones.
• Ureteral stents can negatively impact patient quality of life.
• Stent removal without cystoscopy, using extraction strings, is an alternative to traditional methods.

Purpose of the Study:

• To compare the costs and outcomes of ureteral stent removal with versus without extraction strings.
• To address urologists' concerns regarding risks associated with extraction strings, such as dislodgement and infection.
• To evaluate the overall benefit of using extraction strings for ureteral stent removal.

Main Methods:

• Retrospective study comparing patients with ureteral stents with (n=58) and without (n=82) extraction strings after URS.
• Ureteral stents with strings were removed by pulling the string; stringless stents were removed cystoscopically.
• Postoperative morbidity and patient medical expenses were assessed.

Main Results:

• Patients with extraction strings had significantly shorter stent dwell times (5.3 vs. 11.2 days) and lower removal costs (8.97 vs. 455 CNY).
• Six patients with extraction strings experienced accidental dislodgement, incurring additional costs (345 CNY).
• No significant differences in costs related to urinary tract infection, renal colic, or lower urinary tract symptoms (LUTS) were observed between groups. Overall costs were lower with extraction strings (86.7 vs. 507.9 CNY).

Conclusions:

• Ureteral stent removal with extraction strings offers significant cost savings for patients.
• Despite a potential increase in stent dislodgement, the benefits of reduced dwell time and lower overall costs favor the use of extraction strings.
• Most patients are likely to benefit from the cost-effectiveness and convenience of ureteral stents with extraction strings.