Summary Background Indwelling ureteral stents are commonly placed in urologic surgeries where optimal urinary drainage is necessary. In the pediatric population, removing a stent without retrieval string (SWOS) requires a secondary operation and additional anesthetic exposure. Although these burdens can be mitigated through the placement of a stent with retrieval string (SWS), fears of complications may prevent widespread adoption of this practice by pediatric urologists. Objective The authors sought to assess the differential cost of removing SWS and SWOS. It was hypothesized that costs associated with removing SWS are significantly lower than those associated with removing SWOS, without increasing complications. Study design A retrospective chart review was performed on pediatric patients undergoing common urologic surgeries with concurrent stent placement at a single tertiary referral center. Charges and healthcare costs surrounding the removal of ureteral stents were evaluated using the institution-specific ratio of cost to charges, by estimating lost wages, and by exploring differences in poststent healthcare-related events that incur additional cost. Results A total of 109 patients with a median age of 5 years (range: 6 months–20 years) were reviewed. A total of 29 patients had SWS, and 80 had SWOS. The theoretical cost of SWS removal in clinic was $400.48 compared with $2290.86 ± $119.30 for operative removal of SWOS, with mean difference of $1890.38 (P Discussion With rising healthcare expenditures, physicians must be able to provide cost-effective treatment while not compromising safety or outcomes. Unlike prior analyses of cost related to the type of the stent used, the present study specifically reviewed costs of removing SWS versus SWOS and evaluated rates of costly complications. The study findings provide a preliminary basis for advocating the more economical use of SWS when indicated. Lack of power and heterogeneity of the groups need to be addressed in future analyses with larger, matched cohorts. Conclusion Removal of SWS is more cost-effective than that of SWOS while maintaining similar safety outcomes and should be considered in certain pediatric urology cases to decrease healthcare cost. SWS should be preferred for uncomplicated ureteroscopy, but benefits are less certain in ureteral reconstruction; further studies are needed. Table . Summary of findings Patient demographics SWS, n = 29 SWOS, n = 80 P-value Age, years, median (IQR) 16 (9.5, 17) 2.9 (1, 10) Gender (%) 0.19 Female 19 (66) 40 (50) – Male 10 (34) 40 (50) – Original surgery type (%) Ureteroscopy 14 (48) 23 (29) – Re-implant ± UU ± tapering 1 (3) 27 (34) – Pyeloplasty 14 (48) 30 (38) – Stent duration, days, median (IQR) 10 (6, 14) 35 (28, 42) Total cost of removal $400.48 a $2290.86 ± 119.30 Complications among the ureteral reconstruction group b (%) SWS, n = 15 SWOS, n = 57 Any 4 (27) 20 (35) 0.76 UTI 2 (13) 9 (16) 1.00 Minor complications c with the ED visit 2 (13) 6 (11) 0.67 Early dislodgment 1 (7) 4 (7) 1.00 SWS, stent with retrieval string; SWOS, stent without retrieval string; IQR, interquartile range; UTI, urinary tract infection; UU, ureteroureterostomy; ED, emergency department. a Estimated cost due to lost wages. b Includes re-implant ± UU ± tapering and pyeloplasty via any approach. c Includes bladder spasms, pain, and gross hematuria with the ED visit.
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