Category: Clinical Stones: Medical Management

MP10-5 - Comparing Costs of Dissolution Therapy to Percutaneous Nephrolithotomy for the Treatment of Uric Acid Stones

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective : Dissolution therapy and percutaneous nephrolithotomy (PCNL) are two treatment options for patients with large uric acid stones. We herein compare the costs of dissolution therapy to PCNL in patients with a large, presumed uric acid stone burden.


Methods : Retrospective chart review of patients who received dissolution therapy at our institution from January 2007 to February 2017 for presumed uric acid stones. Baseline demographics, rates of stone clearance, complications, need for secondary intervention, and total overall costs related to medical care (clinic visits, procedures, laboratory and imaging tests, and medications) were collected. Dissolution therapy costs were compared to those for index patients treated with PCNL, including a standard 23-hour overnight stay and costs for one pre- and three post-operative office visits. Cost for stent removal 1 week post-operatively as well as follow-up imaging consisting of CT at 3 months and KUB and renal ultrasound at 12 months were also tabulated. Costs of standard preventative medication (Potassium citrate 20mEq tid between 3 and 12 month post-operative visits) were also included for these index patients. All charges were obtained via our institution’s Billing and Coding department based on corresponding procedural codes, while medication costs represent the average obtained from three high-volume national pharmacies in the area. 


Results : 24 patients underwent dissolution therapy for uric acid stones, with a mean (SD) stone burden of 3.4 (±2.3) cm.  14 (58.3%) patients had complete stone clearance, 7 (29.2%) had partial clearance, and 3 (12.5%) were unable to complete therapy due to side effects. 4 (16.7%) patients underwent a surgical intervention in addition to the dissolution therapy, 3 (12.5%) with URS and 1 (4.2%) with PCNL. The mean (SD) total cost for all patients was $12,079 (±$16,415). In the non-surgical group, mean (SD) cost was $5,404 (±$4,115), $5,932 (±$4,700) for complete responders and $5,082 (±$2,387) for partial responders. In patients who underwent a surgical procedure (URS or PCNL) the mean (SD) cost was $43,785 (±$15,875). The costs of our index PCNL patients were $32,340 and $43,508 for less than and greater than 2cm, respectively.


Conclusions : Variation exists in the total cost of dissolution therapy, particularly in patients undergoing adjunct surgical procedures. When used as monotherapy, dissolution therapy is more cost-effective compared to PCNL in patients with a large, presumed uric acid stone burden.

John L. Cooper

Urology Resident
The Ohio State University Wexner Medical Center
Columbus, Ohio

Michael W. Sourial

Assistant Professor of Urology
The Ohio State University Wexner Medical Center
Columbus, Ohio

Hemant Chaparala

Urology Resident
The Ohio State University Wexner Medical Center
Columbus, Ohio

Chad Gridley

Urology Resident
The Ohio State University Wexner Medical Center
Columbus, Ohio

Lawrence Jenkins

Assistant Professor of Urology
The Ohio State University Wexner Medical Center
Columbus, Ohio

Bodo E. Knudsen

Director, Comprehensive Kidney Stone Program
Ohio State University
Columbus, Ohio