Economic impact of ureteric stone composition on treatment costs: A retrospective analysis

Objective: To assess the effect of stone composition on the overall costs of treating urolithiasis. Materials and Methods: A retrospective review of patients with ureteric stones presenting to the Emergency Department (ED), confirmed via computed tomography (CT) scans. Data included clinical and imaging findings, hospital admissions, re-visits, surgical interventions and treatment costs. The analysis considered stone characteristics (size, location, composition), clinical presentation (sepsis, renal function) and history of urolithiasis. Results: Between January 2018 and January 2020, 4813 patients underwent abdominal CT scans in the Emergency Department (ED), with ureteral stones identified in 805 cases (16.7%). After applying inclusion criteria, 773 patients (96%) were included. The mean age was 50 years (SD = 15), with 22% females and 78% males. The average stone size was 4.73 mm (SD = 2.1). Fever (5.4% versus 2.1%, p = 0.032) and positive urine cultures (30.9% versus 9.9%, p < 0.001) were more common in females, while males had higher serum creatinine levels ( p < 0.001). Spontaneous stone expulsion was higher in males (60.3% versus 49.4%, p = 0.016), whereas females underwent more surgical interventions (50.6% versus 39.7%, p = 0.016). Ureteroscopy was the most common procedure (87.8%), with percutaneous nephrolithotomy (PCNL) (1.4%) and SWL (1.4%) performed less frequently. Stone composition analysis (available for 31% of patients) revealed struvite stones incurred the highest treatment costs ($14,251), followed by calcium phosphate ($13,135), uric acid ($10,758), calcium oxalate monohydrate ($9697) and calcium oxalate dihydrate ($9373). Conclusion: Stone composition is a critical determinant of treatment costs for ureteric stones, with struvite stones being the most expensive to manage. These findings highlight the need to consider stone composition when evaluating the financial aspects of urolithiasis treatment. Level of evidence: 4