Cost analysis of flexible ureterorenoscopy

The development of ureteroscopy, in the first instance with rigid ureteroscopes, and subsequently with flexible ureteroscopes, has been a huge contribution to the non‐operative removal of urinary tract calculi. Access can be gained to stones in the ureter and to many in the kidney. Two reports presented in this section examined aspects of ureteroscopy; the cost of the procedure, and whether stenting of the ureter is required after removing ureteric stones by this means. OBJECTIVE To assess the costs of flexible ureterorenoscopy. MATERIALS AND METHODS Data were collected prospectively for 100 cases using a new flexible ureteroscope (DUR8, Circon ACMI, Stamford, USA), including the indications for flexible ureterorenoscopy, use of laser probes, disposable instrumentation, and the cost and timing of ureteroscope repair. RESULTS Of the 100 procedures 68 were for stone disease, 21 for known or suspected transitional cell carcinoma (TCC), six were diagnostic only and five were for pelvi‐ureteric junction obstruction. The ureteroscope was repaired after the 29th and 88th cases. The ability of the ureteroscope to deflect was maintained throughout. At the time of purchase the ureteroscope was listed at £15 000 and each repair/exchange currently costs £4200, thus the total expenditure on the ureteroscope was £23 400. Total expenditure on ancillary equipment was £28 727, of which £22 927 was on disposables and £5800 on 10 laser probes. CONCLUSION In this series the costs of the ancillary equipment exceeded the purchase and maintenance of the ureteroscope, and we expect this trend to continue in the long term. The advent of more durable ureteroscopes may ultimately reduce the frequency of costly repairs. The cost of disposables should be considered in planning the budget.