Category: Clinical Stones: Equipment (stents, lasers, guidewires, sheaths)

MP27-5 - Impact of double-J stent removal with a single use cystoscope dedicated to this procedure: A cost analysis

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

In many institutions, the double-J (DJ) stent removal is performed in an endoscopic room (ER) or operating room (OR) and requires video equipment, reusable cystoscopes and graspers. Recently, a single use flexible cystoscope (SUC) with integrated grasper dedicated to DJ stent removal has been released on the market.
We aimed to compare the cost of a DJ removal in the ER/OR with reusable instruments to the cost of DJ removal with the SUC dedicated to this procedure in a consultation room.


Methods :

This retrospective monocentric study included all the DJ stent removals performed in 2016 in a French academic institution. We performed
a cost analysis of various variables involved in DJ removals: costs of reusable cystoscope and grasper (including material purchase, maintenance, reprocessing by disinfection or sterilization), cost of video equipment (including material purchase, maintenance and light cable reprocessing), and cost of ER or OR occupancy for 30 minutes. These costs were compared to the cost of a DJ removal performed in an outpatient consultation room with the SUC, including its purchase, waste process, and room occupancy for 30 minutes.


Results :

During the year, 603 DJ stent removals were performed in the ER and 6 in the operating room (OR). Total occupational times were 301.5 hours for the ER and 3.0 hours for the OR. Total cost per DJ stent removal in the ER was 330 euros (4.5 euros for material purchase, 4.7 euros for material maintenance, 30.5 euros for disinfection, 30 euros for sterilization, and 260 euros for ER occupancy). Total cost per DJ stent removal in the OR was 425 euros (14.6 euros for material purchase and maintenance, 30.5 euros for disinfection, 30 euros for sterilization and 350 euros for OR occupancy). Total cost per DJ stent removal in consultation is 285 euros (250 euros for material purchase, 0.6 euros for waste process, and 34.8 euros for box occupancy).


Conclusions :

This study found that DJ removal in consultation with SUC could make an economy of 45 euros compared to the cost in the ER and 140 euros in the OR. Such outcomes may lead the hospital to consider other options such as single use cystoscope dedicated for DJ stents removal as it does not require a dedicated place or equipment for its use and offer substantial economy. Other potential advantages to move the DJ removal activity in consultation room are to offer more time to other activities in the ER and OR, an immediate availability of the SUC, and decreased risk of urinary tract infection with this device.

Steeve S. Doizi

Urologist
Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, AP-HP, Hôpital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France

Vincent De Coninck

Urologist
AZ Klina
Brasschaat, Antwerpen, Belgium

Vincent De Coninck graduated as a medical doctor from the Free University of Brussels, Belgium (VUB) in 2011. He became a certified urologist in 2017 after a training at the University Hospital of Brussels (Prof. Dr. Dirk Michielsen) and OLV Aalst (Prof. Dr. Alex Mottrie), where he developed a special interest in the minimal invasive treatment of benign and malignant pathologies. In the same year, he became Fellow of the European Board of Urology.
In 2018, he completed a one-year fellowship program of the Endourological Society in Paris, France under the supervision of Prof. Dr. Olivier Traxer. During that fellowship, he also obtained a diploma in urolithiasis, organized by Dr. Michel Daudon at the Sorbonne University in Paris, France. Afterwards, he was trained in HoLEP by Dr. Karin Lehrich in Berlin, Germany.
Currently, he is completing a three-month fellowship under the supervision of Dr. Guido Giusti in Milan, Italy. In December 2018, he will start working as an endourologist in AZ Klina, Brasschaat, Belgium. He will focus on the medical and surgical treatment of kidney stones and benign prostatic obstruction (HoLEP) and he will continue publishing articles relating to the management of patients with renal stone disease.

Etienne X. Keller

Fellow of the ES
Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, AP-HP, Hôpital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France

Emmanuelle Granier


Paris, Ile-de-France, France

Raphaelle Pesque


Paris, Ile-de-France, France

Olivier O. Traxer

Professor
Sorbonne Universite, GRC n020 Lithiase Renale, AP-HP, Hospital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France