Ureteral stent removal using an extraction string after uncomplicated ureteroscopy: a cost-benefit analysis

Some urologists used the extraction strings for removal of ureteral stent without cystoscopy. While some urologists may have concern about perceived risks, including accidental dislodgement, infection, renal?colic?and lower urinary tract symptoms. Therefore, we performed a retrospective study to help address this conflict. Patients who had an indwelling ureteral stent with(n=58) or without(n=82) extraction strings inserted after ureteroscopy for unilateral ureteral stones were enrolled. For ureteral stent removal, the strings were pulled by physician, no string-stents were removed by cystoscopic. Postoperative morbidity was assessed. Patients' medical expense due to postoperative morbidity was collected. Patients with extraction string had shorter stent dwell time((5.3±1.8 versus 11.2±3.2 day, P= .001) and less cost (8.97±3.07 versus 455±0 CNY, P = .001)) for ureteral stent removal. However, six patients with extraction string had an accidental dislodgement, additional medical expenses were 345±137.9 CNY. There was no difference in the cost due to urinary tract infection, renal?colic?and LUTS between the two groups. The overall cost in patients without an extraction string was significantly more than in patients with an extraction string (86.7±167.7 versus 507.9±147.8 CNY, p =.008). Despite an increase in stent dislodgement related risks to the extraction string, it results in significant cost savings for patients, and most of patients remove with extraction strings might benefit from it