Stone Disease - Cost Comparison of Percutaneous Nephrolithotomy With and Without Intraoperative Cone-beam Computed Tomography: 18-month Postoperative Analysis

Sep 30, 2026

Uploaded by James

Residual fragments (RFs) after percutaneous nephrolithotomy (PCNL) raise the risk of stone-related events (SREs) such as reinterventions and emergency department (ED) visits, increasing overall expenses. Intraoperative cone-beam computed tomography (CBCT) can detect and guide removal of RFs to improve stone-free rates and potentially reduce SREs. This study compares total inhospital costs of standard PCNL versus CBCT-PCNL across an 18-month follow-up to evaluate whether higher upfront procedural costs are offset by reduced downstream care.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Background and objective

Methods

Key findings and limitations

Conclusions and clinical implications

Patient summary

Introduction

Achieving stone-free status in PCNL

Role of CBCT and prior evidence

Cost considerations and adoption barriers

EUROPEAN U ROLOGY OPEN SCIENC E 8 3 ( 2 0 26 ) 1 25 – 13 2 available [at www.sciencedirect.com](at www.sciencedirect.com) journal [homepage: www.eu-openscience.europeanurology. com](homepage: www.eu-openscience.europeanurology. com) | Stone Disease
Cost Comparison of Percutaneous Nephrolithotomy With and Without Intraoperative Cone-beam Computed Tomography:
18-month Postoperative Analysis
Rosanne van Eea,, Chris A. Suijkera,,*, Antoinette D.I. van Asseltb,c, Inge M. van Oort a, Riemer A. Kingmaa, Stijn Roemelinga
a Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; b Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; c Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands | | | --- | --- | | Article info | Abstract
Background and objective: Residual fragments (RFs) after percutaneous nephrolithotomy (PCNL) increase the risk of stone-related events (SREs) such as reinterventions and emergency department (ED) visits. Intraoperative cone-beam computed tomography (CBCT) facilitates detection and removal of RFs to improve stone-free rates and potentially reduce SREs. To determine whether the initial increase in surgical costs for CBCT in a hybrid operating room (OR) is offset by a reduction in overall expenses by minimizing SREs, we compared the total inhospital health care costs of standard PCNL versus CBCT-PCNL over an 18-mo period.
Methods: Data from a previous randomized controlled trial including 80 patients undergoing CBCT-PCNL and 80 undergoing conventional PCNL were analyzed. Procedural costs were calculated by multiplying operative duration by the Dutch reference price per minute, and adding disposable costs. Follow-up costs included costs for complications, SREs (reinterventions, ED visits, drainage, admissions), imaging, and consultations during 18 mo.
Key findings and limitations: Assuming utilization rates of 42% for a hybrid OR and 92% for a conventional OR and following reference prices, we calculated mean total costs per patient of €8725 for the CBCT group and €8564 for the control group, with a difference of € 167. The 40.2% higher procedural costs for hybrid-OR PCNL were nearly offset by 38.3% lower follow-up, complication, and SRE costs. Limitations include the single-center design, incomplete cost standardization, and the exclusion of non-hospital costs such as productivity loss.
Conclusions and clinical implications: While PCNL with CBCT in a hybrid OR increases operative costs, it lowers SREs and unplanned care expenses. Even at a signiﬁcantly
These authors contributed equally to this work and share ﬁrst authorship.
*
Corresponding author. Department of Urology, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands. Tel. +31 50 3612380 .
E-mail address: [c.a.suijker@umcg.nl](c.a.suijker@umcg.nl) (C.A. Suijker). | | Article history:
Accepted December 5, 2025
Associate Editor:
Silvia Proietti | | | Keywords:
Percutaneous nephrolithotomy Intraoperative cone-beam computed tomography
Cost comparison
Stone-related events Randomized controlled trial Urolithiasis
Residual fragments | | | | | [https://doi.org/10.1016/j.euros.2025.12.002](https://doi.org/10.1016/j.euros.2025.12.002) 2666-1683/􀀁 2025 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)). lower hybrid OR utilization rate, total health care costs remain comparable, so PCNL-CBCT can facilitate predictable resource use and efﬁcient care, with potential beneﬁts for patients and health care systems. Patient summary: A new technique using CT (computed tomography) scans during surgery

FAQs

Why is intraoperative CBCT considered after percutaneous nephrolithotomy?

CBCT can better detect residual fragments and enable targeted removal during the same procedure, which may improve stone-free rates and reduce stone-related events.

How were costs calculated in the 18-month comparison?

Procedural costs were estimated using operative duration multiplied by a Dutch reference price per minute plus disposable costs. Follow-up costs included complications, SREs (e.g., reinterventions and ED visits), imaging, and consultations over 18 months.

What was the overall cost difference between CBCT-PCNL and standard PCNL?

Mean total costs per patient were €8725 for the CBCT group and €8564 for the control group, a difference of €167, with higher procedural costs largely offset by lower follow-up, complication, and SRE costs.

Sep 30, 2026

Uploaded by James