Comparison of ureteric stent removal procedures using reusable and single-use flexible cystoscopes following ureteroscopy and lasertripsy: a micro cost analysis

INTRODUCTION: Diagnostic pressure on endoscopy suite can lead to delay in flexible cystoscopic stent removal. We compare the cost and organizational impact of reusable flexible cystoscope versus single-use, flexible cystoscope with a built-in stent grasper (Isiris(®)). MATERIAL AND METHODS: Data for the reusable cystoscopic stent removal performed in endoscopy room, group A (period 1) were compared to Isiris disposable stent removal performed in outpatient clinic, group B (period 2). We chose the same calendar months in successive years for these two different groups (9 months each). A micro cost analysis was performed evaluating the impact on costs, complications and organizational benefit. RESULTS: A total of 72 patients (37, group A; 35, group B) were included with no significant differences in age and gender ratio. The mean procedure time was 14.4 and 2.2 minutes, and the mean stent dwell time was 26.8 and 15.4 days in groups A and B respectively (p <0.001). In group A, 5 patients (14%) developed stent encrustation, of which 3 needed a ureteroscopic removal subsequently. No complication occurred in group B. More staff on average were needed for procedures done in group A, than group B (p <0.001). The number of patients who had cancer diagnostic wait of >2 weeks for flexible cystoscopy and the mean number of days they waited, reduced from 16 to 3, and 21 days to 3 days respectively between period 1 to period 2. The cost per procedure between group A and group B was £267.2 and £252.62 (p <0.05) if the cost of managing complications was not considered, and £365.40 and £252.62 (p <0.001) if the cost of managing complications was also considered. CONCLUSIONS: Isiris significantly reduced stent dwell time, procedural time and staff needed to carry out the stent removals. It also allowed the procedures to be done in the outpatient setting thereby reducing the organizational pressure on endoscopy related diagnostic procedures.