International Urology and Nephrology

, Volume 49, Issue 5, pp 753–761 | Cite as

A cost analysis of stenting in uncomplicated semirigid ureteroscopic stone removal

  • Stephan Seklehner
  • Karl-Dietrich Sievert
  • Richard Lee
  • Paul F. Engelhardt
  • Claus Riedl
  • Thomas Kunit
Urology - Original Paper



To evaluate the outcome and the costs of stenting in uncomplicated semirigid ureteroscopic stone removal.

Materials and methods

A decision tree model was created to evaluate the economic impact of routine stenting versus non-stenting strategies in uncomplicated ureteroscopy (URS). Probabilities of complications were extracted from twelve randomized controlled trials. Stone removal costs, costs for complication management, and total costs were calculated using Treeage Pro (TreeAge Pro Healthcare version 2015, Software, Inc, Williamstown Massachusetts, USA).


Stone removal costs were higher in stented URS (€1512.25 vs. €1681.21, respectively). Complication management costs were higher in non-stented procedures. Both for complications treated conservatively (€189.43 vs. €109.67) and surgically (€49.26 vs. €24.83). When stone removal costs, costs for stent removal, and costs for complication management were considered, uncomplicated URS with stent placement yielded an overall cost per patient of €1889.15 compared to €1750.94 without stent placement. The incremental costs of stented URS were €138.25 per procedure.


Semirigid URS with stent placement leads to higher direct procedural costs. Costs for managing URS-related complications are higher in non-stented procedures. Overall, a standard strategy of deferring routine stenting uncomplicated ureteroscopic stone removal is more cost efficient.


Ureteroscopy Cost–benefit analysis Ureteral calculi Urolithiasis 



The authors thank Mrs. Vögl, Mr. Matula and Mr. Schwartz for their assistance in collecting costing data and Mrs. Wald for proofreading.

Compliance with ethical standards

Conflict of interest

The authors declares that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.


  1. 1.
    Hughes B, Wiseman OJ, Thompson T et al (2014) The dilemma of post-ureteroscopy stenting. BJU Int 113:184–185CrossRefPubMedGoogle Scholar
  2. 2.
    Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, Seitz C (2013) Guidelines on urolithiasis. In: EAU guidelines, edition presented at the 25th EAU annual congress, Barcelona 2010 ISBN 978-90-79754-71-7Google Scholar
  3. 3.
    Perez Castro E, Osther PJ, Jinga V et al (2014) Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: the Clinical Research Office of the Endourological Society ureteroscopy global study. Eur Urol 66:102–109CrossRefPubMedGoogle Scholar
  4. 4.
    Hesse A, Brandle E, Wilbert D, Kohrmann KU, Alken P (2003) Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 versus 2000. Eur Urol 44:709–713CrossRefPubMedGoogle Scholar
  5. 5.
    Scales CD Jr, Smith AC, Hanley JM, Saigal CS (2012) Prevalence of kidney stones in the United States. Eur Urol 62:160–165CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Saigal CS, Joyce G, Timilsina AR (2005) Direct and indirect costs of nephrolithiasis in an employed population: Opportunity for disease management? Kidney Int 68:1808–1814CrossRefPubMedGoogle Scholar
  7. 7.
    Netto NR Jr, Ikonomidis J, Zillo C (2001) Routine ureteral stenting after ureteroscopy for ureteral lithiasis: Is it really necessary? J Urol 166:1252–1254CrossRefPubMedGoogle Scholar
  8. 8.
    Shao Y, Zhuo J, Sun XW, Wen W, Liu HT, Xia SJ (2008) Nonstented versus routine stented ureteroscopic holmium laser lithotripsy: a prospective randomized trial. Urol Res 36:259–263CrossRefPubMedGoogle Scholar
  9. 9.
    Srivastava A, Gupta R, Kumar A, Kapoor R, Mandhani A (2003) Routine stenting after ureteroscopy for distal ureteral calculi is unnecessary: results of a randomized controlled trial. J Endourol 17:871–874CrossRefPubMedGoogle Scholar
  10. 10.
    Cheung MC, Lee F, Leung YL, Wong BB, Tam PC (2003) A prospective randomized controlled trial on ureteral stenting after ureteroscopic holmium laser lithotripsy. J Urol 169:1257–1260CrossRefPubMedGoogle Scholar
  11. 11.
    Ibrahim HM, Al-Kandari AM, Shaaban HS, Elshebini YH, Shokeir AA (2008) Role of ureteral stenting after uncomplicated ureteroscopy for distal ureteral stones: a randomized, controlled trial. J Urol 180:961–965CrossRefPubMedGoogle Scholar
  12. 12.
    Cevik I, Dillioglugil O, Akdas A, Siegel Y (2010) Is stent placement necessary after uncomplicated ureteroscopy for removal of impacted ureteral stones? J Endourol 24:1263–1267CrossRefPubMedGoogle Scholar
  13. 13.
    Damiano R, Autorino R, Esposito C et al (2004) Stent positioning after ureteroscopy for urinary calculi: the question is still open. Eur Urol 46:381–387 (discussion 7–8) CrossRefPubMedGoogle Scholar
  14. 14.
    Baseskioglu B, Sofikerim M, Demirtas A, Yenilmez A, Kaya C, Can C (2011) Is ureteral stenting really necessary after ureteroscopic lithotripsy with balloon dilatation of ureteral orifice? A multi-institutional randomized controlled study. World J Urol 29:731–736CrossRefPubMedGoogle Scholar
  15. 15.
    Hussein A, Rifaat E, Zaki A, Abol-Nasr M (2006) Stenting versus non-stenting after non-complicated ureteroscopic manipulation of stones in bilharzial ureters. Int J Urol 13:886–890CrossRefPubMedGoogle Scholar
  16. 16.
    Wang CJ, Huang SW, Chang CH (2009) Indications of stented uncomplicated ureteroscopic lithotripsy: a prospective randomized controlled study. Urol Res 37:83–88CrossRefPubMedGoogle Scholar
  17. 17.
    Isen K, Bogatekin S, Em S, Ergin H, Kilic V (2008) Is routine ureteral stenting necessary after uncomplicated ureteroscopic lithotripsy for lower ureteral stones larger than 1 cm? Urol Res 36:115–119CrossRefPubMedGoogle Scholar
  18. 18.
    Xu Y, Wei Q, Liu LR (2009) A prospective randomized trial comparing non-stented versus routine stented ureteroscopic holmium laser lithotripsy. Saudi Med J 30:1276–1280PubMedGoogle Scholar
  19. 19.
    Borboroglu PG, Amling CL, Schenkman NS et al (2001) Ureteral stenting after ureteroscopy for distal ureteral calculi: a multi-institutional prospective randomized controlled study assessing pain, outcomes and complications. J Urol 166:1651–1657CrossRefPubMedGoogle Scholar
  20. 20.
    Chen YT, Chen J, Wong WY, Yang SS, Hsieh CH, Wang CC (2002) Is ureteral stenting necessary after uncomplicated ureteroscopic lithotripsy? A prospective, randomized controlled trial. J Urol 167:1977–1980CrossRefPubMedGoogle Scholar
  21. 21.
    Denstedt JD, Wollin TA, Sofer M, Nott L, Weir M, D'A Honey RJ (2001) A prospective randomized controlled trial comparing nonstented versus stented ureteroscopic lithotripsy. J Urol 165:1419–1422Google Scholar
  22. 22.
    Jeong H, Kwak C, Lee SE (2004) Ureteric stenting after ureteroscopy for ureteric stones: a prospective randomized study assessing symptoms and complications. BJU Int 93:1032–1034 (discussion 4–5) CrossRefPubMedGoogle Scholar
  23. 23.
    Al-Ba’adani T, Ghilan A, El-Nono I, Alwan M, Bingadhi A (2006) Whether post-ureteroscopy stenting is necessary or not? Saudi Med J 27:845–848PubMedGoogle Scholar
  24. 24.
    Seklehner S, Laudano MA, Jamzadeh A, Del Pizzo JJ, Chughtai B, Lee RK (2014) Trends and inequalities in the surgical management of ureteric calculi in the USA. BJU Int 113:476–483CrossRefPubMedGoogle Scholar
  25. 25.
    Joshi HB, Stainthorpe A, MacDonagh RP, Keeley FX Jr, Timoney AG, Barry MJ (2003) Indwelling ureteral stents: evaluation of symptoms, quality of life and utility. J Urol 169:1065–1069 (discussion 9) CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  • Stephan Seklehner
    • 1
    • 2
  • Karl-Dietrich Sievert
    • 2
  • Richard Lee
    • 3
  • Paul F. Engelhardt
    • 1
    • 2
  • Claus Riedl
    • 1
  • Thomas Kunit
    • 2
  1. 1.Department of UrologyLandesklinikum Baden-MödlingBadenAustria
  2. 2.Department of UrologyParacelsus Medical University SalzburgSalzburgAustria
  3. 3.Department of UrologyWeill Medical College of Cornell UniversityNew YorkUSA

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