HIDDEN COSTS IN URETEROSCOPY 20-51-17

Stone migration during Ureteroscopy is a well-known phenomenon and is accepted as a sequela and the subsequent cost of management of that stone has never been addressed.

The causes of stone migration are several, but the single most significant factor is the irrigation of the Ureter during Ureteroscopy. The current irrigation devices that are available, with the exception of the UPIS, all require the use of 2 hands or an assistant or a hand and a foot operation and these are cumbersome, lack accuracy and have not kept pace with all the other advances that have been made in Ureteroscopic accessories, like the nitinol baskets, digital cameras and different types of wires and a very significant improvement in the optics.

When a stone migrates up the ureter it is usually accepted as a sequela and now the distal stone becomes a proximal or a mid-ureteral stone and it either gets fragmented by a laser or stented and treated with shock waves. All of this makes it more invasive in the case of the Laser and much more expensive in the case of shock wave treatment. In addition to these costs and risks, the need for different types of ureteral catheters for different purposes, like for example, the use of a cone tip catheter for retrograde pyelogram, an open ended catheter for collection of cytological specimen and the use of dual lumen catheter for injecting contrast and maintaining access, all add up the cost of Ureteroscopy and these are often never mentioned in the cost analysis of the procedure. A simple distal ureteral stone have now become a complicated and a more invasive and a more expensive procedure.

In these changing times in health care system where the aim is to cut cost, one of the most common approaches is to have personnel in the OR to be Jack-of-all-trades, so that they can be more versatile and can work in all specialties. A very promising idea indeed but in reality, it ends up having personnel in the OR who are neither jack-of-all-trades nor master of any. With the exception of the personnel in major teaching institutions, the OR personnel in community hospitals have very little knowledge on Ureteroscopy and are of minimal help.

The result of poorly trained staff, inefficient irrigation system, use of different ureteral catheters, prolongs operating time and all of this raises the cost of stone management.

A new device, the UPIS makes the Urologist independent, places the control of irrigation in the hand of the Urologist, making it more precise, minimizing the risk of stone migration and thus saves time and money. The added benefit of the injection port with a built in check valve, eliminates the use of different ureteral catheters and thus saving over all costs.