AUA 2018: Controlling the Costs of Flexible Ureteroscopy
Mazzucchi explained that costs associated with flexible ureteroscopy are significantly different in the developing world. The main sources of increased expenditure are increased costs of the devices and poor surgical/paramedic staff training. He mentioned that there were costs associated with transportation, storage, and repair of the flexible ureteroscopes and that some governments also levy a tax on the utilization of these devices. He suggested several ways to reduce these costs including utilizing portable laser devices, considering using low-cost single use flexible ureteroscopes, reducing the number of disposables (using one wire, not always using a ureteral access sheath, etc), and performing more procedures in an outpatient setting. Additional cost-saving measures are found in educating surgeons, residents and staff to properly handle and clean the flexible ureteroscopes. He also mentioned altering surgical technique by considering starting with rigid ureteroscopy and if not able to treat the stone in that manner to then switch to flexible ureteroscopy.
Chew concluded the panel session by advocating the use of shock wave lithotripsy (SWL) as a way to reduce costs associated with flexible ureteroscopy. He mentioned that in his practice in Canada they routinely use SWL for distal ureteral stones and that these patients were rendered stone free after the first SWL in 77.6% of cases and after a second SWL in 90.2% of cases.
Pais’ take home messages were to use thoughtful pre- and post-op testing, reduce disposable inventory, improve handling of the flexible ureteroscopes by providing better education for the surgeons along with the staff and to consider modifying surgical technique.
Presented by: Vernon Pais, MD, Dartmouth-Hitchcock
Panelists: Ben Chew, MD Brian Matlaga, MD Michael Lipkin, MD Eduardo Mazzucchi, MD
Written by: Roshan Patel, Department of Urology, University of California-Irvine, medical writer for UroToday.com at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA