To examine the relative costs of prone percutaneous nephrostolithotomy (PCNL) versus PCNL performed with the patient in the Galdakao-modified supine Valdivia (GMSV) position to determine whether a cost differential exists.
We compared prone PCNL with PCNL using GMSV positioning. Cost data were obtained from the urology departmental and hospital billing offices at our institution and from the 2011 local Medicare reimbursement scales. The costs were divided into 5 major categories: surgeon fees, anesthesia fees, surgical supplies, hospital-related fees, and lost revenue.
The overall cost of prone PCNL ranged from $23 423 to $24 463, and the cost for PCNL performed with GMSV positioning ranged from $24 725 to $25 830. The difference between the 2 positions ranged from approximately $1302 for stones ≤2 cm to $1367 for stones >2 cm. The lost office revenue because of the requirement for a second surgeon was estimated at $1987.
Our assessment of the cost for prone versus GMSV PCNL technique found GMSV positioning to be more costly. The presence of 2 surgeons was the main driver of the cost differential, because it resulted in more equipment use, with greater instrument repair costs and higher surgeon fees. It also brings into consideration the opportunity cost of having a second surgeon in the operating room and not in the office.
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- Percutaneous pyelolithotomy: a new extraction technique.Scand J Urol Nephrol. 1976; 10: 257-259
- Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations.J Urol. 2005; 173: 1991-2000
- Percutaneous nephrolithotomy: simplified technic (preliminary report).Arch Esp Urol. 1987; 40: 177-180
- Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position.J Urol. 1998; 160: 1975-1978
- Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access.BJU Int. 2007; 100: 233-236
- Systematic review and meta-analysis of percutaneous nephrolithotomy for patients in the supine versus prone position.J Endourol. 2010; 24: 1941-1946
- International cooperation in endourology: supine vs. prone percutaneous nephrolithotomy in obese patients.J Urol. 2011; 185: e730
- The debate over percutaneous nephrolithometry positioning: a comprehensive review.J Urol. 2011; 186: 20-25
- Supine versus prone position during percutaneous nephrolithotomy: a report from the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global study.J Endourol. 2011; 25: 1619-1625
- Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy?.Eur Urol. 2008; 54: 1393-1403
- Percutaneous nephrostolithotomy versus flexible ureteroscopy/holmium laser lithotripsy: cost and outcome analysis.J Urol. 2009; 182: 1012-1017
- Classification of percutaneous nephrolithotomy complications using the modified Clavien grading system: looking for a standard.Eur Urol. 2008; 53: 184-190
- Beyond prone position in percutaneous nephrolithotomy: a comprehensive review.Eur Urol. 2008; 54: 1262-1269
- Supine percutaneous nephrolithotomy, is it really effective?.Urol J. 2009; 6: 73-77
- Third prize: contemporary percutaneous nephrolithotripsy: 1585 procedures in 1338 consecutive patients.J Endourol. 2007; 21: 824-829
- Complications in percutaneous nephrolithotomy.Eur Urol. 2007; 51: 899-906
- Anatomical variation between the prone, supine, and supine oblique positions on computed tomography: implications for percutaneous nephrolithotomy access.Urology. 2012; 79: 67-71
- Modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access: a prospective randomized trial.Eur Urol. 2008; 54: 196-202
- Complete supine percutaneous nephrolithotripsy comparison with the prone standard technique.J Endourol. 2008; 22: 2513-2517
- Supine versus prone position during percutaneous nephrolithotomy: a report from the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study.J Endourol. 2011; 25: 1619-1625
- Modified supine percutaneous nephrolithotomy for large kidney and ureteral stones: technique and results.Eur Urol. 2012; 61: 164-170
- Percutaneous lithotripsy in Valdivia-Galdakao decubitus position: our experience.J Endourol. 2009; 23: 1615-1620
- Position: prone or supine is the issue of percutaneous nephrolithotomy.J Endourol. 2010; 24: 931-938
- Evaluation of overall costs of currently available small flexible ureteroscopes.Urology. 2003; 62: 218-222
- Location and etiology of flexible and semirigid ureteroscope damage.Urology. 2005; 66: 958-963
- Frequency of ureteroscope damage seen at a tertiary care center.J Urol. 2006; 176: 607-610
- Ureteroscope cleaning and sterilization by the urology operating room team: the effect on repair costs.J Endourol. 2009; 23: 903-905
- Cost control using flexible ureteroscopy on a larger, more complex stone burden.J Urol. 2011; 185: e558
- An independent analysis of flexible cystoscope repairs and cost.J Urol. 2007; 178: 2098-2102
Published online: August 23, 2012
Accepted: June 23, 2012
Received: February 27, 2012
Financial Disclosure: The authors declare that they have no relevant financial interests.
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.