Comparative radiation exposure and costs associated with percutaneous nephrostomy tube vs ureteric stent for emergency renal decompression
The infected, obstructed kidney is a urological emergency requiring urgent decompression. There are recognised risks and benefits between percutaneous nephrostomy tubes (PCNT) or retrograde ureteric stents (US) with patient factors, institutional facilities, clinician experience and preference influencing the decision. Financial cost and comparative exposure to ionising radiation are however not typically considered when deciding which modality of decompression is utilised. The following study reviewed and compared the cost and ionising radiation exposure between retrograde insertion of a US and insertion of PCNT for the acute management of an infected, obstructed kidney.
All patients who underwent retrograde insertion of a US or insertion of a PCNT for an infected, obstructed kidney at a tertiary hospital in Perth, Western Australia between 01 February 2015 to 31 June 2017.
177 US&[prime]s and 142 PCNT&[prime]s met eligibility criteria for review. A cost analysis was conducted to account for the costs of medical devices, imaging equipment and personnel. The cost of procedures is appreciably higher during an after-hours setting when staff are required to be recalled to the hospital and salary penalty rates apply. Taking into consideration medical devices, imaging equipment and personnel, after-hours insertion of a retrograde US was approximately $650 compared to $2350 for insertion of a PCNT. PCNT insertion requires mobilisation of a specialist interventional suite with specialised and experienced staff including a consultant interventional radiologist. In contrast, a retrograde US can be safely inserted by minimally experienced urology staff in a standard operating theatre. The average effective dose of ionising radiation for insertion of a PCNT compared to retrograde insertion of a US as calculated from the median DAP was 0.49mSv versus 0.174mSV respectively.
Urgent decompression of an infected, obstructed kidney should occur without delay. Insertion of a PCNT is associated with a significantly increased financial cost compared with retrograde insertion of a US. The radiation dose administered for both cases is small, however the dose administered during insertion of a PCNT is 3 times higher. Patient safety remains of paramount importance, however cost and radiation exposure should be considered when deciding upon the modality of decompression.