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Management of Residual Fragments Following Percutaneous Nephrolithotomy: A Cost Analysis
Michelle J Semins, Elias Hyams, Brian R Matlaga
Johns Hopkins Hospital, Baltimore, MD

Introduction: Residual fragments after percutaneous nephrolithotomy (PNL) have historically been managed with second-look flexible nephroscopy. As the utilization of tubeless PNL becomes more widespread, there has been an increased interest in second-look ureteroscopy for patients with residual stone fragments. We performed a cost analysis of immediate second-look flexible nephroscopy and second-look ureteroscopy for patients with residual stones following PNL.
Methods: We reviewed the records of patients who underwent PNL and then required a secondary procedure for the management of residual fragments following the initial PNL procedure. Cost data were obtained from administrative billing records. We defined total costs as operating room and post-anesthesia care unit expenses, as well as laboratory and professional (surgical and anesthesia) fees.
Results: The mean costs for second-look percutaneous nephroscopy were almost twice as high as the mean costs for second-look flexible ureteroscopy: \.72 versus \.93, p<0.05. We did not include in the analysis the costs of the initial PNL procedure for either group.
Conclusions: Our findings suggest that the costs of second-look PNL are significantly greater than the costs of second-look ureteroscopy for patients with a residual stone burden following PNL. It is important to note that costs are only one metric that are used to evaluate surgical efficacy for stone-removal procedures. However, an emerging surgical paradigm for patients with large or complex stone burdens may be a tubeless PNL procedure followed by flexible ureteroscopy for the management of a residual stone burden.


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