LAUSR

INTRODUCTION AND OBJECTIVE: Minimally invasive, outpatient procedures remain in vogue in the field of urology for both cost savings and patient satisfaction. The adoption of mini percutaneous nephrolithotomy (PCNL) from pediatric cases in the adult population allows the patient to undergo lithotripsy of larger stone burden with a smaller caliber sheath. Reduced bleeding, improved visibility, and shortened hospital stay are a few suggested benefits of this approach. In this study, we have attempted to quantify the potential cost savings in our experience utilizing mini PCNL in patients with stones >1.5 compared to traditional PCNL. METHODS: A retrospective review was performed over the period June 2016 to August 2019 to collect all patient records who underwent mini PCNL. Patients were excluded if less than 1.5 cm of stone was treated. The costs assessed were based on a single institutions charges for hospitalization, surgical fees and instruments used during the procedures. RESULTS: In this study, greater than 1.5 cm of stone was treated in 173 of the 189 mini PCNLs. The average age was 53.8, BMI was 32.1, and the population was 54% female. In 53% of cases, multiple stones were present and average stone burden was 2.5 cm (1.56.6 cm). Average surgical time was 74 minutes with 28 cc of blood loss. Stents were left in 45% (78/173) of patients and nephrostomy tubes in 24% (42/173). Average date of discharge was postoperative day 0.6 with 63.5% of patients discharged on the day of surgery compared to 2.3 days for PCNL over the same period. Typical cost of mini PCNL was $777(USD) versus $1659 for PCNL and cost for nephrostomy tubes and stents were $70 and $50 respectively. CONCLUSIONS: Practitioners may offer mini PCNL as a primary therapy for stones >1.5 cm for expeditious, minimally invasive stone clearance. The potential cost savings for stones treatment in this population is reflected in both instrument costs as well as the hospital cost associated with additional days of inpatient care.