Ureteral Stent Removal Using an Extraction String After Uncomplicated Ureteroscopy: A Cost-Benefit Analysis

Purpose: Some urologists use 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 resolve this conflict. Materials and Methods: Patients who had an indwelling ureteral stent with (n = 58) or without (n = 82) extraction strings inserted after ureteroscopy for unilateral ureteral stone were enrolled. For ureteral stent removal, the strings were pulled by physician, no string-stents were removed by cystoscopy. Postoperative morbidity was assessed. Patients' medical expense due to postoperative morbidity was gathered. Results: Patients with extraction string had shorter stent dwell time (5.3 +/- 1.8 versus 11.2 +/- 3.2 days, P = .001) and less costly (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 of 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). Conclusion: Despite an increase in stent dislodgement related risks to the extraction string, it results in significant cost savings for patients, and the most patients remove with extraction strings might benefit from it.