ORLANDO, FL (UroToday) - Two very important studies were reported from the University of Texas Southwestern, at Dallas.

Dr. Pearle and colleagues at the University of Texas Southwestern, at Dallas reviewed their series of contemporary synchronous bilateral PCNL (SB-PCNL) and compared clinical outcomes, cost and physician reimbursement to estimates for a comparable staged bilateral PCNL. Seventeen patients underwent SB-PCNL and the outcomes, direct and component costs, and physician reimbursements were compared to the similar variables for 152 unilateral PCNLs. Operative time, length of stay, direct costs and physician costs were determined according to CPT codes for stone complexity to match case complexity per renal unit. The mean patient age for the SB-PCNL group was 51 years with 60% of the patients being male and staghorn calculus in 25%.

Using CT criteria 4 patients were completely stone free after the initial procedure; second look nephroscopy was performed on at least one side in 10 patients with residual fragments and complications occurred in 4 patients (2 hydrothoraces, 2 post-operative fevers greater than 38 degrees) and none required transfusion.

Room time, hospital length of stay and direct costs were higher in the estimated stage procedures when renal units were matched for CPT codes. Conversely, physicians were reimbursed 11 to 46% less when SB-PCNL procedures were performed.

Therefore, it is readily apparent that SB-PCNL benefits the patients and third party payers by incurring shorter cumulative room/anesthesia times and length of stays while decreasing direct cost. However, as has become more prevalent in recent years, there is a disincentive for the surgeon, who is penalized financially for performing SB-PCNL.

Presented by Margaret S. Pearle, MD, et al., at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday Contributing Editor Elspeth M. McDougall, MD, FRCSC

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