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Introduction: We sought to compare re-treatment rates between shockwave lithotripsy and ureteroscopy to evaluate the effectiveness of these modalities. Additionally, we aimed to compare costs associated with re-treatment., Methods: The Healthcare Cost and Utilization Project State Ambulatory Surgery Database for Florida from 2009 to 2015 was used to identify patients who underwent shockwave lithotripsy or ureteroscopy. Patients were tracked for subsequent stone surgeries within 3 months, 6 months and 1 year. Costs of care were estimated and descriptive analyses were performed. A multivariable logistic regression model was used to determine predictors of a second procedure., Results: A total of 98,011 patients underwent initial shockwave lithotripsy or ureteroscopy. Of those who underwent initial shockwave lithotripsy 21.2% had a second surgery (shockwave lithotripsy or ureteroscopy) within 3 months compared to 10% of patients who underwent initial ureteroscopy (p <0.01). On multivariable analysis, patients who underwent initial shockwave lithotripsy were more than twice as likely (OR 2.4, 95% CI 2.3-2.5) to undergo a second procedure within 3 months. Older patients were also more likely to undergo a second surgery, while African Americans, Hispanics, uninsured patients and patients with more comorbidities had decreased odds of undergoing a second surgery (all p <0.05). The per patient cost of the initial procedure plus re-treatment at the 3-month mark was $6,239 for initial shockwave lithotripsy and $5,319 for initial ureteroscopy (p <0.01)., Conclusions: Patients undergoing shockwave lithotripsy are more likely than those undergoing ureteroscopy to have additional stone procedures, making shockwave lithotripsy a more expensive intervention.

Introduction: Genitourinary foreign bodies are uncommon, have only been reported in single center case reports or series and little is known about national incidence. Commonly cited risk factors include psychiatric disorders, drug or alcohol intoxication, or autoerotic stimulation. A population study was performed to characterize the incidence, treatments and economic burden of the genitourinary foreign body., Methods: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample for the years 2012 to 2014 and the Florida State Emergency Department Database and State Inpatient Database for the years 2012 to 2014 were used. Patients were identified as having a diagnosis of genitourinary foreign body by ICD-9 diagnosis codes (939.0, 939.3, 939.9). Patients included in state databases were tracked longitudinally to characterize recurrent visits., Results: Between 2012 and 2014, 1,125 patients were admitted to United States hospitals with a primary diagnosis of genitourinary foreign body. Patients were predominately male (83.6%) and white race (68.4%). Compared to all other inpatients those with genitourinary foreign body were more likely to have a diagnosis of mental health disease (56.9% vs 30.0%, p <0.005) or substance abuse (11.1% vs 5.9%, p <0.005). Overall 64.9% of patients required operative intervention. Mean adjusted cost per admission was $6,835 (SD $360), resulting in $2.61 million in annual national economic burden., Conclusions: This study is the first to our knowledge to use population level data to characterize the national incidence and patient characteristics of genitourinary foreign bodies, a condition that costs payers $2.6 million annually.