1937 OFFICE-BASED ENDOUROLOGY USING FLUOROSCOPIC GUIDANCE: CLINICAL OUTCOMES AND COST-EFFECTIVENESS

Abstract

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal1 Apr 20111937 OFFICE-BASED ENDOUROLOGY USING FLUOROSCOPIC GUIDANCE: CLINICAL OUTCOMES AND COST-EFFECTIVENESS Boris Gershman, Brian Eisner, and Dianne Sacco Boris GershmanBoris Gershman Boston, MA More articles by this author , Brian EisnerBrian Eisner Boston, MA More articles by this author , and Dianne SaccoDianne Sacco Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2118AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Endourologic procedures are increasingly being performed in the office. We examined the clinical outcomes and cost-effectiveness of endourologic procedures performed in the office using standard fluoroscopy under local anesthesia. METHODS We performed a retrospective review of all patients who underwent ureteral stent placement, ureteral stent exchange, or ureteral catheterization with retrograde pyeolography or BCG instillation in the office under topical anesthesia using fluoroscopic guidance from 9/2008 - 12/2009. Cost data was estimated from Medicare 2010 non-facility physician fees and Ambulatory Payment Classification (APC) reimbursements. 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). No procedure was terminated due to patient discomfort. 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 renal units. Indications for stent placement or exchange were ureteral stone (14/30, 46.7%), malignant extrinsic ureteral compression (8/30, 26.7%), benign extrinsic ureteral compression (3/30, 10%), ureteral stricture (2/30, 6.7%), ureteropelvic junction obstruction (2/30, 6.7%), and hydronephrosis of unknown etiology (1/30, 3.3%). The total cost of stent placement/stent exchange/retrograde pyelography is $599/$599/$346 when performed in the office compared with $2,306/$2,306/$2,279 when performed in the ambulatory surgical suite. The total cost savings for the 38 patients in this study was approximately $95,601, including excess cost from failure in the office. CONCLUSIONS Ureteral stent placement, exchange, and catheterization can be performed safely and effectively in the office in both men and women. This avoids general anesthesia, provides convenience to patient and clinician, and represents a substantial cost-savings for the healthcare system. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e775 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Boris Gershman Boston, MA More articles by this author Brian Eisner Boston, MA More articles by this author Dianne Sacco Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...