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Probabilistic modeling also indicated that the introduction of RIRS as the first line of treatment was least likely to be cost-effective, when compared to other options of introducing RIRS as the second, third, or fourth line of treatment. Conclusion Performing RIRS as early as possible can be recommended for eligible patients to reduce the overall failure, even if it is not as cost-effective as performing RIRS later.Purpose Although both chronic kidney disease (CKD) and diabetes mellitus (DM) are considered factors increasing the risk of