Ten-Year Prospective Evaluation of a Nurse-Led Virtual Stone Clinic: Transforming Kidney Stone Surveillance Through Safe,Cost-Effective,and Sustainable Care

Abstract

Introduction:

Virtual stone clinics (VSCs) provide an alternative to face-to-face (F2F) surveillance for patients with kidney stone disease, particularly those who are asymptomatic or at high risk of recurrence. This study presents a 10-year prospective evaluation of a nurse-led VSC established at a UK tertiary center prior to the COVID-19 pandemic.

Patients and Methods:

All patients referred to the VSC between March 2014 and December 2024 were included. We collected data on demographics, stone characteristics, imaging, clinic activity, outcomes, emergency presentations, and environmental and economic impact. We calculated cost modeling and CO₂ emissions based on travel distance, fuel type, and National Health Service tariffs in the United Kingdom.

Results:

A total of 854 patients (529 men, 325 women; mean age 61.9 years) were reviewed over 2,917 appointments (mean 3.41/patient). High-risk features were present in 26.1%. Most patients had stable stones or passed them spontaneously (83%), with only 6.9% presented to the emergency department. VSC follow-up kept patients from having to travel 27,138 km and saved over 560 hours of patient and health care time. Estimated CO₂ savings ranged from 4.0 to 4.4 tons. The estimated total money saved was more than £200,000 thanks to lower clinic fees and fuel expenditures.

Conclusion:

Over a decade, the VSC demonstrated safety, cost-efficiency, and environmental sustainability. These findings support wider adoption of virtual surveillance models within the health care systems while acknowledging the absence of a contemporaneous F2F comparator group.