The Increased Risk of Complicated Ureteral Stones in the Era of COVID-19 Pandemic

Double J Stents and Reno-Ureteral Lithiasis: Dynamic Changes in Management during the COVID-19 Pandemic

PURPOSE

To provide an evidence-based review of the use of ureteral stents in managing reno-ureteral lithiasis during the COVID-19 pandemic.

MATERIALS AND METHODS

A literature search was conducted between 2020 and 2023 using the PubMed and SCOPUS databases. As a part of the search query, we entered "ureteral stents" OR "double J stent" AND "renal colic" OR "ureteral obstruction" OR "reno-ureteral lithiasis" AND "COVID-19 Pandemic" OR "SARS-CoV-2 infection".

RESULTS

Patients with lithiasis should be categorized into low priority, intermediate priority, high priority, and emergency under the COVID-19 pandemic scenario to manage their delay and save resources, including healthcare professionals, beds, and ventilators. However, immediate interventions are necessary for individuals at risk of life-threatening septic complications. During the COVID-19 pandemic, the feasibility of conducting or resuming elective activity depended on local circumstances, the accessibility of beds and ventilators, and the execution of screening protocols. If lithiasis surgery is delayed, consequences and increased effort will be inevitable. It is possible that teleconsultation could help guide these patients and cut down on unnecessary visits and exposure.

CONCLUSIONS

COVID-19 has shifted treatment options for urinary stones, with ureteral stents being a safe, efficient, and cost-effective option for managing urolithiasis. Decompression is essential in emergency situations, while ureteral stents reduce the risk of infection and hospital visits.

The genetic associations of COVID-19 on genitourinary symptoms

Background

Recently emerged reports indicated that patients with coronavirus disease 2019 (COVID-19) might experience novo genitourinary symptoms after discharge. Nevertheless, the causal associations and underlying mechanisms remain largely unclear.

Methods

Genome-wide association study (GWAS) statistics for COVID-19 and 28 genitourinary symptoms with consistent definitions were collected from the COVID-19 Host Genetic Initiative, FinnGen, and UK Biobanks. Mendelian randomization (MR) analyses were applied to explore the causal effects of COVID-19 on genitourinary symptoms by selecting single-nucleotide polymorphisms as instrumental variables. Meta-analyses were conducted to evaluate the combined causal effect. Molecular pathways connecting COVID-19 and its associated disorders were evaluated by weighted gene co-expression network analysis (WGCNA) and enrichment analyses to extract insights into the potential mechanisms underlying the connection.

Results

The MR and meta-analyses indicated that COVID-19 was causally associated with increased risk for calculus of the lower urinary tract (LUTC, OR: 1.2984 per doubling in odds of COVID-19, 95% CI: 1.0752-1.5680, p = 0.007) and sexual dysfunction (SD, OR: 1.0931, 95% CI: 1.0292-1.1610, p = 0.004). Intriguingly, COVID-19 might exert a slight causal protective effect on the progression of urinary tract infections (UTIs) and bladder cancer (BLCA). These results were robust to sensitivity analyses. Bioinformatic analyses indicated that the inflammatory-immune response module may mediate the links between COVID-19 and its associated disorders at the molecular level.

Conclusions

In response to post-COVID-19 symptoms, we recommend that COVID-19 patients should strengthen the prevention of LUTC and the monitoring of sexual function. Meanwhile, the positive effects of COVID-19 on UTIs and BLCA should attach equal importance.

Effects of Delayed Surgical Intervention Following Emergency Department Presentation on Stone Surgery Complexity

Introduction and Objective: Prior literature had demonstrated increased stone burden and higher rates of staged surgery in individuals of lower socioeconomic status (SES). Low SES individuals are more likely to experience delays in definitive stone surgery after initial presentation to the emergency department (ED) for kidney stones. This study aims to investigate the relationship between delays in definitive kidney stone surgery and the subsequent need for percutaneous nephrolithotomy (PNL) and/or staged surgical procedures using a statewide data set. Methods: This retrospective cohort study gathered longitudinal data from 2009 to 2018 using the California Department of Health Care Access and Information data set. Patient demographic characteristics, comorbidities, diagnosis/procedure codes, and distance were analyzed. Complex stone surgery was defined as initial PNL and/or undergoing more than one procedure within 365 days of initial intervention. Results: A total of 1,816,093 billing encounters from 947,798 patients were screened, resulting in 44,835 patients with ED visits for kidney stones followed by a urologic stone procedure. Multivariable analysis revealed that relative to patients who underwent surgery within 1 month of initial ED visit for stone disease, patients were at increased odds of undergoing complex surgery if waiting ≥6 months (odds ratio [OR] 1.18, p = 0.022), ≥1 year (OR 1.29, p < 0.001), and ≥3 years (OR 1.43, p < 0.001). Conclusions: Delays in definitive stone surgery after initial ED encounter for stone disease were associated with increased likelihood of undergoing a complex stone treatment.

Multidrug-Resistant (MDR) Urinary Tract Infections Associated with Gut Microbiota in CoV and Non-CoV Patients in a Urological Clinic during the Pandemic: A Single Center Experience

The aim of the study was to compare the profile of COVID-19 (CoV)-infected patients with non-COVID-19 (non-CoV) patients who presented with a multidrug-resistant urinary tract infection (MDR UTI) associated with gut microbiota, as well as analyze the risk factors for their occurrence, the types of bacteria involved, and their spectrum of sensitivity.

METHODS

We conducted a case-control study on patients admitted to the urology clinic of the "Parhon" Teaching Hospital in Iasi, Romania, between March 2020 and August 2022. The study group consisted of 22 CoV patients with MDR urinary infections associated with gut microbiota. For the control group, 66 non-CoV patients who developed MDR urinary infections associated with gut microbiota were selected. Electronic medical records were analyzed to determine demographics, characteristics, and risk factors. The types of urinary tract bacteria involved in the occurrence of MDR urinary infections and their sensitivity spectrum were also analyzed.

RESULTS

Patients in both groups studied were over 60 years of age, with no differences in gender, environment of origin, and rate of comorbidities. Patients in the CoV group had a higher percentage of urosepsis (54.5% versus 21.2%, p < 0.05) and more hospitalization days (9.27 versus 6.09, p < 0.05). Regarding risk factors, the two groups had similar percentages of previous urologic interventions (95.45% versus 96.97%, p > 0.05), antibiotic therapy (77.3% versus 87.9%, p > 0.05), and the presence of permanent urinary catheters (77.27% versus 84.85%, p > 0.05). Escherichia coli (31.8% versus 42.4%, p > 0.05), Klebsiella spp. (22.7% versus 34.8%, p > 0.05), and Pseudomonas aeruginosa (27.3% versus 9.1%, p > 0.05) were the most common urinary tract bacteria found in the etiology of MDR urinary infections in CoV and non-CoV patients. A high percentage of the involved MDR urinary tract bacteria were resistant to quinolones (71.4-76.2% versus 80.3-82%, p > 0.05) and cephalosporins (61.9-81% versus 63.9-83.6%, p > 0.05), both in CoV and non-CoV patients.

CONCLUSIONS

Patients with urological interventions who remain on indwelling urinary catheters are at an increased risk of developing MDR urinary infections associated with gut microbiota resistant to quinolones and cephalosporins. Patients with MDR UTIs who have CoV-associated symptoms seem to have a higher rate of urosepsis and a longer hospitalization length.

Did the COVID-19 Pandemic Restrict Access to Emergency Urological Services: Assessment of Reorganisation Effectiveness for Hospital Treatment

Urolithiasis derived renal colic is a common urological condition. If treated properly, the disease resolves without complications; if not treated, it causes infection and renal failure. The COVID-19 restrictions impacted hospitalised treatment of diseases. We analysed the impact of COVID-19 on renal colic treatment at a hospital in Poland. Clinical and demographic data of patients treated during the COVID-19 era were compared with those treated before this pandemic. During the COVID-19 restrictions, renal colic patient hospital admissions fell significantly. However, more patients presented with chronic renal colic symptoms and urinary tract infections. Nevertheless, the degree of hydronephrosis and the number and location of stones did not differ between the two groups. No marked changes were observed in the chosen treatment options. The observed decrease in emergency admissions of patients with acute renal colic with a simultaneous increase in the rate of infectious stones might indicate that some patients requiring urgent medical help did not report to the emergency department or came later than they would before the pandemic, reporting more serious symptoms. One plausible explanation for this may be that the reorganisation of the healthcare system restricted access to urological care. Moreover, some patients may have delayed their visit to the hospital due to the fear of contracting the SARS-CoV-2 coronavirus.

Impact of COVID-19 on the management and outcomes of ureteric stones in the UK: a multicentre retrospective study

OBJECTIVES

To determine if management of ureteric stones in the UK changed during the coronavirus disease 2019 (COVID-19) pandemic and whether this affected patient outcomes.

PATIENTS AND METHODS

We conducted a multicentre retrospective study of adults with computed tomography-confirmed ureteric stone disease at 39 UK hospitals during a pre-pandemic period (23/3/2019-22/6/2019) and a period during the pandemic (the 3-month period after the first severe acute respiratory syndrome coronavirus-2 case at individual sites). The primary outcome was success of primary treatment modality, defined as no further treatment required for the index ureteric stone. Our study protocol was published prior to data collection.

RESULTS

A total of 3735 patients were included (pre-pandemic 1956 patients; pandemic 1779 patients). Stone size was similar between groups (P > 0.05). During the pandemic, patients had lower hospital admission rates (pre-pandemic 54.0% vs pandemic 46.5%, P < 0.001), shorter mean length of stay (4.1 vs 3.3 days, P = 0.02), and higher rates of use of medical expulsive therapy (17.4% vs 25.4%, P < 0.001). In patients who received interventional management (pre-pandemic 787 vs pandemic 685), rates of extracorporeal shockwave lithotripsy (22.7% vs 34.1%, P < 0.001) and nephrostomy were higher (7.1% vs 10.5%, P = 0.03); and rates of ureteroscopy (57.2% vs 47.5%, P < 0.001), stent insertion (68.4% vs 54.6%, P < 0.001), and general anaesthetic (92.2% vs 76.2%, P < 0.001) were lower. There was no difference in success of primary treatment modality between patient cohorts (pre-pandemic 73.8% vs pandemic 76.1%, P = 0.11), nor when patients were stratified by treatment modality or stone size. Rates of operative complications, 30-day mortality, and re-admission and renal function at 6 months did not differ between the data collection periods.

CONCLUSIONS

During the COVID-19 pandemic, there were lower admission rates and fewer invasive procedures performed. Despite this, there were no differences in treatment success or outcomes. Our findings indicate that clinicians can safely adopt management strategies developed during the pandemic to treat more patients conservatively and in the community.

Lessons learned after the disruption caused by COVID-19 in the management of urolithiasis: An example of adaptation in a high-volume center

Background

The aim was to determine the impact of COVID-19 pandemic on urolithiasis presentation and management.

Methods

In this retrospective study, we comparatively evaluated urgent and elective procedures due to urolithiasis during the early eight months of the COVID-19 pandemic (March 1, 2020, to October 31, 2020) compared to the same period a year before, and between waves. The student’s t-test, chi-square test, Mann–Whitney U test and Fisher’s exact test were used to compare the patients’ characteristics and outcomes between the two periods and waves.

Results

Five hundred and thirty procedures were included. The overall numbers of surgical procedures due to urolithiasis were similar between pre-pandemic and pandemic periods. Regarding elective surgery, our data draw attention to the increased complication rate in the pandemic times, but no statistically significant differences in terms of types of procedures and need for complementary treatments were observed. We noted that patterns of presentation of complicated renal colic were different during COVID-19 pandemic, with a higher number of days after the onset of symptoms and a higher proportion of patients presenting acute kidney injury. Furthermore, a significant increase of creatinine levels at presentation in first wave was detected, and a growth in the number of urgent procedures after the first wave was noted, owing to the delay in urolithiasis treatment and diagnosis.

Conclusion

The COVID-19 pandemic has negatively affected both urgent and elective management of urolithiasis. Lessons about the management of urolithiasis in this context should be learned to avoid fatal complications and improve standards of care.

Impact of COVID-19 pandemic on patients with obstructing urinary stones complicated by infection

Objective

To assess the influence of COVID-19-imposed life changes on presentation and outcomes of patients with obstructing urinary stones complicated by infection.

Patients and methods

All patients presenting with obstructing urinary stones and infection 1 year before the pandemic (March 2019 to February 2020; n = 66) and 1 year since its onset (March 2020 to February 2021; n = 45) were enrolled. Demographics, clinical presentation, laboratory panel, stone characteristics and outcomes were compared between groups. Univariate and multivariate logistic regression models were performed for analysis.

Results

The COVID-19 period was characterised by younger patients, female predominance, higher temperature at presentation and more bilateral obstructing stones (p < 0.05). The admission rate to intensive care units was double that of the pre-pandemic period, whereas time between diagnosis and treatment was similar. The univariate analysis revealed higher rates of severe sepsis (odds ratio [OR] = 3, p = 0.01), systemic inflammatory response syndrome (SIRS) ≥ 2 (OR = 2.9, p = 0.01) and risk, injury, failure, loss of kidney function and end-stage kidney (RIFLE) criteria ≥ 1 (OR = 2.2, p = 0.04) in the pandemic period group. The multivariate analyses revealed the COVID-19 period as being the sole variable associated with severe sepsis (OR = 3.1, p = 0.02), SIRS ≥ 2 (OR = 3.8, p = 0.005) and RIFLE ≥ 1 (OR = 2.6, p = 0.05).

Conclusions

The pandemic period was characterised by a worse clinical state at presentation of patients with obstructing urinary stones complicated by infection, probably reflecting delay in arrival to emergency services.

Non-COVID outcomes associated with the coronavirus disease-2019 (COVID-19) pandemic effects study (COPES): A systematic review and meta-analysis

BACKGROUND

As the Coronavirus Disease-2019 (COVID-19) pandemic continues, healthcare providers struggle to manage both COVID-19 and non-COVID patients while still providing high-quality care. We conducted a systematic review/meta-analysis to describe the effects of the COVID-19 pandemic on patients with non-COVID illness and on healthcare systems compared to non-pandemic epochs.

METHODS

We searched Ovid MEDLINE/EMBASE/Cochrane Database of Systematic Reviews/CENTRAL/CINAHL (inception to December 31, 2020). All study types with COVID-pandemic time period (after December 31, 2019) with comparative non-pandemic time periods (prior to December 31, 2019). Data regarding study characteristics/case-mix/interventions/comparators/ outcomes (primary: mortality; secondary: morbidity/hospitalizations/disruptions-to-care. Paired reviewers conducted screening and abstraction, with conflicts resolved by discussion. Effect sizes for specific therapies were pooled using random-effects models. Risk of bias was assessed by Newcastle-Ottawa Scale, with evidence rating using GRADE methodology.

RESULTS

Of 11,581 citations, 167 studies met eligibility. Our meta-analysis showed an increased mortality of 16% during the COVID pandemic for non-COVID illness compared with 11% mortality during the pre-pandemic period (RR 1.38, 95% CI: 1.28-1.50; absolute risk difference: 5% [95% CI: 4-6%], p<0.00001, very low certainty evidence). Twenty-eight studies (17%) reported significant changes in morbidity (where 93% reported increases), while 30 studies (18%) reported no significant change (very low certainty). Thirty-nine studies (23%) reported significant changes in hospitalizations (97% reporting decreases), while 111 studies (66%) reported no significant change (very low certainty). Sixty-two studies (37%) reported significant disruptions in standards-to-care (73% reporting increases), while 62 studies (37%) reported no significant change (very low certainty).

CONCLUSIONS

There was a significant increase in mortality during the COVID pandemic compared to pre-pandemic times for non-COVID illnesses. When significant changes were reported, there was increased morbidity, decreased hospitalizations and increased disruptions in standards-of-care.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020201256 (Sept 2, 2020).

[Lessons learned about the disruption caused by COVID-19 in the management of urolithiasis: An example of adaptation in a high-volume centre]

BACKGROUND

 The aim was to determine the impact of COVID-19 pandemic on urolithiasis presentation and management.

METHODS

 In this retrospective study we comparatively evaluated urgent and elective procedures due to urolithiasis during the early eight months of the COVID-19 pandemic (March 1, 2020 to October 31, 2020) compared to the same period a year before, and between waves. The student's t-test, chi-square test, Mann-Whitney U test and Fisher's exact test were used to compare the patients' characteristics and outcomes between the two periods and waves.

RESULTS

530 procedures were included. The overall number of surgical procedures due to urolithiasis were similar between pre-pandemic and pandemic periods. Regarding elective surgery, our data draw attention to the increased complication rate in the pandemic times, but no statistically significant differences in terms of types of procedures and need for complementary treatments were observed. We noted that patterns of presentation of complicated renal colic were different during COVID-19 pandemic, with a higher number of days after the onset of symptoms and a higher proportion of patients presenting acute kidney injury. Furthermore, a significant increase of creatinine levels at presentation in 1^st wave was detected. A growth in the number of urgent procedures after the 1^st wave was noted, owing to the delay in urolithiasis treatment and diagnosis.

CONCLUSION

The COVID-19 pandemic has negatively affected both urgent and elective management of urolithiasis. Lessons about the management of urolithiasis in this context should be learned to avoid fatal complications and improve standards of care.

Exacerbation of Congenital Hydronephrosis as the First Presentation of COVID-19 Infection in Children

Background. Congenital hydronephrosis is one of the most common abnormalities of the upper urinary tract, which can be exacerbated by a variety of intrinsic or extrinsic triggers. The urinary tract system is one of the major organs complicated by COVID-19 infection. Case Presentations. Here, we report five patients with an established diagnosis of congenital hydronephrosis, who presented with acute abdominal pain and fever and an abrupt increase in the anteroposterior pelvic diameter (APD). Patients had a previous stable course and were under regular follow-up with serial ultrasonographic studies. They underwent surgery or supportive treatment due to the later exacerbation of hydronephrosis. Based on the clinical and imaging findings, no plausible etiologies for these exacerbation episodes, including infection, nephrolithiasis, or abdominal masses, could be postulated. The common aspect in all these patients was the evidence of a COVID-19 infection. Conclusions. Infection with COVID-19 in children with antenatal hydronephrosis may exacerbate the degree of hydronephrosis and renal APD in ultrasonography, which itself may be mediated by the increase in inflammatory mediators.

The Impact of early COVID-19 pandemic on the Presentation and Management of Urinary Calculi Across the Globe - A Systematic Review

Introduction It is acknowledged that the COVID-19 pandemic has had a major impact on healthcare services around the globe with possible worse outcomes. It has resulted in stretch of resources with cancelled or delayed procedures. Patients with urinary calculi have also suffered the negative impact. This systematic review aims to assess the impact of the early COVID-19 pandemic on the presentation and management of urinary calculi around the globe. Methods We reviewed the impact of early COVID-19 on the clinically important aspects of stone disease using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We searched Medline, Embase and Central databases using themes of (COVID-19 OR Sars-Cov-2 OR pandemic OR coronavirus AND kidney stone, urinary calculi, urolithiasis and similar allied terms. Inclusion criteria were studies with data on both pre and COVID-19 period covering one or more of eight clinical domains. Results Our search returned 231 studies, after removal of duplicates, of which 18 studies were included for analysis. The number of patients presenting to hospital declined by 21-70% at the beginning of the pandemic while majority of studies reported increased associated complications. There are mixed reports in terms of delay to presentation and use of conservative management. There was a consistent trend towards reduction in elective procedures with wide variations (shock wave lithotripsy 38-98%, PCNL 94-100% and ureteroscopy 8%-98%) There was a trend towards increased nephrostomy insertion with the onset of the pandemic. Conclusion This review demonstrated the differences in the number of patients presenting to hospital, complication rates and management of urinary calculi, including surgical interventions, with the onset of the COVID-19 pandemic. It offers baseline global information that would help understand the impact of early pandemic, variations in practices and be useful for future comparisons.

COVID-19 effect on perioperative findings of flexible/semi-rigid ureterorenoscopic lithotripsy: A match-pair analysis

PURPOSE

If not treated on time with proper management options, urolithiasis cause serious morphologic and functional alterations in the involved renal units. Like many other pathologies, the diagnosis, treatment, and follow-up principles of patients with urinary stones have been negatively affected by the unestimated changes in the healthcare systems dealing intensively with COVID-19 patients. In this present study, we aimed to evaluate and present the possible effects of COVID-19 infection on the ureterorenoscopic stone treatment.

MATERIALS AND METHODS

Clinical and procedural characteristics of 96 patients undergoing flexible and/or rigid ureterorenoscopy because of urolithiasis between March 2020 and January 2021 were evaluated in a retrospective manner. Obtained data were evaluated after match-pair analysis in a comparative manner between cases with a positive medical history of COVID-19 infection (Group 1, n: 48) and those without any COVID-19 infection (Group 2, n: 48).

RESULTS

There was no statistically significant difference between the two groups of cases with respect to age, gender, associated comorbidities, and stone characteristics (p > 0.05). The mean serum creatinine level was determined to be higher in Group 1 than in Group 2 (1.15 ± 0.59 mg/dl, 0.83 ± 0.21 mg/dl, p = 0.007, respectively). Evaluation of the operative parameters revealed longer mean time from diagnosis to surgery (33.5 ± 14.27 vs 12.12 ± 6.33 days, p = 0.001), operating time, median length of stay in hospital along with higher additional intervention rates, and Clavien-Dindo complication scores again in Group 1 (p < 0.05).

CONCLUSION

Our results indicate that the presence of COVID-19 infection anamnesis may affect the clinical and operative parameters of ureteroscopic stone management in cases with urolithiasis due to the possible effects of renal units damage and longer waiting time. Urologists may be aware of these unestimated problems during and after the intervention to take necessary measures for a safe and successful ureteroscopic stone removal.

Changes in practice patterns of nephrolithiasis in the era of the coronavirus disease 2019 pandemic: a review

PURPOSE OF REVIEW

The coronavirus disease 2019 (COVID-19) pandemic led to a drastic change in healthcare priorities, availability of resources and accommodation of different needs and scenarios. We sought to review the effect of the pandemic on different aspects of nephrolithiasis.

RECENT FINDINGS

The pandemic resulted in a significant impact on management of patients with nephrolithiasis around the world. A significant decrease in patient presentation and differences in strategies of management to truncate exposure and surgery time and expedite patient discharge deferring definitive management has been noted. Moreover, new safety measures such as COVID-19 PCR testing prior to surgery and limiting any intervention for COVID-19 positive patients to only life-saving scenarios has been implemented. Different emergency triaging proposals are being used, mainly including high risk patients with septic shock or complete obstruction/renal injury. Moreover, the emergence of telehealth has changed outpatient practice dramatically with a significant adoption to minimize exposure. Lastly, the effect of COVID-19 on renal physiology has been described with significant potential to cause morbidity from immediate or delayed acute kidney. No physiological effect on stone formation has yet been described, and transmission through urine is rare.

SUMMARY

The COVID-19 pandemic has markedly shifted the treatment of nephrolithiasis in many ways, including emergency triage, outpatient care, and definitive management. Although various approaches and algorithms proposed are meant to optimize management in the time of the pandemic, further studies are required for validation.

Barriers in Managing Acute Ureteric Colic Clinical Review and Commentary

With the global prevalence of urolithiasis increasing, the presentation of acute ureteric colic to emergency departments (ED) poses a significant burden on healthcare systems globally. Management strategies for ureteric colic encompass medical expulsion therapy and various interventional modalities aimed at urinary diversion or definitive stone management. By examining potential or established barriers to managing acute ureteric colic, we can minimise strain on healthcare providers while maintaining patient outcomes. This review aims to assess barriers to the management of acute ureteric colic through a comprehensive overview of the current literature. Acute ureteric colic barriers will be assessed throughout a patient's disease progression, borrowing a conceptual framework used to assess barriers in cancer care management. Barriers will be discussed in the context of patient-centred access to healthcare, clinical evaluation and diagnosis, and management. Numerous barriers to healthcare have been identified throughout the natural course of acute ureteric colic, both specific and non-specific. Patient-centred barriers typically arise during the initial onset of acute ureteric colic. Originating from patient awareness and access to healthcare, they include barriers founded on race inequalities, cultural beliefs, geographic location, transportation, and the concept of a universal standard of healthcare. Having accessed healthcare, barriers in the management of acute ureteric colic next occur during the clinical evaluation and diagnosis period. These are typically associated with clinical assessment or diagnostic imaging delays, including underutilisation of ultrasound, nurse-led pathways for faster clinical reviews, and general ED delays. The final period during acute ureteric colic management correlates to clinical management. The inherent unpredictable course of ureteral stones leads to poor prognostication and failed initial management modalities. Additionally, this period deals with periprocedural delays and preventative health. Barriers to the management of acute ureteric colic arise during a patient's journey through accessing healthcare. Reviewing barriers allow further research into areas requiring modification to expedite care and improve outcomes.

Comparison of Management and Outcomes of Symptomatic Urolithiasis during the COVID-19 Pandemic to a Comparative Cohort

Objective

To analyze the clinical presentation and outcomes for patients who presented with symptomatic urolithiasis during the initial months of the COVID-19 pandemic.

Methods

We retrospectively reviewed Emergency Department (ED) presentations from a Philadelphia healthcare system for symptomatic urolithiasis between March and June 2020 and compared these with presentations for the same time period from the year prior. Patient demographics, stone characteristics, management, and clinical outcomes were compared between the 2 years.

Results

One hundred and thirty-nine patients presented during 2020 compared to 269 in 2019. There were fewer patients who presented during the initial COVID-19 pandemic surge who had obesity (37.41% vs 49.44%, P = .024), hyperlipidemia (18.71% vs 31.60, P = .006), and asthma (5.76% vs 16.73%, P = .002). Although overall stone characteristics did not differ between the 2 groups, a larger proportion of patients in 2020 presented with an obstructing stone (81.16% vs 64.1%, P = .001). Patients who presented during the COVID-19 pandemic did not have higher rates of infection, acute kidney injury, or complications. Rates of surgical modalities, emergent procedures, and discharges from the ED were similar between the 2 years.

Conclusion

The COVID-19 pandemic initial surge resulted in fewer ED presentations for symptomatic urolithiasis; however, patients who did present were more likely to have obstructing stones, perhaps due to delaying presentation to avoid COVID-19 exposure in the ED. Despite higher rates of obstruction, clinical outcomes and morbidity were similar.

COVID-19: The impact on urolithiasis treatment in Brazil

Introduction:

It has been more than a year since the first case of Covid-19 was diagnosed in Brazil, and its most problematic feature is the oversaturation of the healthcare system capacity. Urolithiasis is a disease that requires timely and appropriate management. The present study aimed to evaluate the impact of the pandemic in hospital admissions for urolithiasis in the Brazilian public healthcare system.

Materials and Methods:

In this cross-sectional study, hospital admissions were obtained from the Brazilian Public Health Information system. All hospital admissions associated with urolithiasis diagnosis (ICD-10 N20) between March 2017 and February 2021 were analyzed.

Results:

During the COVID-19 outbreak, there was a significant decrease in hospital admissions (p<0.0001). More than 20.000 patients probably did not have the opportunity to undergo their surgeries. The impact of the COVID-19 outbreak on women's admissions was significantly more intense than for men, reducing from 48.91% to 48.36% of the total (p=0.0281). The extremes of age seemed to be more affected, with patients younger than 20 years and older than 60 years having a significant reduction in access to hospital services (p=0.033).

Conclusions:

In conclusion, we have noticed a considerable reduction in overall admissions for the treatment of urolithiasis in the Brazilian public healthcare system during the first year of the Covid-19 pandemic. Women and individuals older than 60 years were especially affected. In contrast, we noted a rise in urgent procedures, comparing with the average of the corresponding period of the three previous years. Recovery plans will be needed while returning to activities to handle the impounded surgical volume.

Quality of Life of Urolithiasis Patients During the COVID-19 Pandemic: A Multi-Institutional Cross-Sectional Study

Purpose The COVID-19 pandemic is an unprecedented global event that has caused significant fear and anxiety across all populations. To date, there have been no studies on how major health crises have affected the stone-related quality-of-life (QOL) of urolithiasis patients. In this multi-institutional study, we investigated whether the fear of COVID-19 affects the QOL of urolithiasis patients during the COVID-19 pandemic using the Fear of COVID-19 Scale (FCV-19S) and the Wisconsin Stone Quality of Life (WISQOL) questionnaires. Materials and Methods Patient-reported data collection occurred between April-October 2020 during the COVID-19 pandemic where many procedures (radiological or surgical) and visits were either delayed or cancelled. The scores generated from patient-reported responses to questionnaires were correlated and then further sub-analyzed dependent on categorical responses related to procedural delays or care and were analyzed via the Student's T-test. A single factor analysis of variance (ANOVA) was performed to analyze varying QOL scores across the FCV-19S quartiles. Results 400 respondents participated in this study. Overall mean total standardized FCV-19S and WISQOL scores (both transformed to min-max 0-100) were 34.3 and 70.3 respectively. A significant inverse correlation (r=-0.265, p<0.0001) was demonstrated suggesting greater COVID-19 fear may result in lower stone-related quality-of-life. A significant difference in fear and QOL scores was observed between the sexes, with women having more COVID-19 fear (35.8 vs. 28.6, p<0.01) and lower stone-related QOL (64.2 vs. 75.2, p<0.01). Quartile ANOVA analysis revealed significant mean difference in WISQOL scores across all FCV-19S score quartiles (p<0.05). Conclusions Using two validated questionnaires (FCV-19S and WISQOL) and correlating patient-reported responses, we found that greater fear for COVID-19 was associated lower stone-related QOL in urolithiasis patients.

Trends in urological emergencies in the Era of COVID-19

PURPOSE

To evaluate trends in emergency room (ER) urological conditions during COVID-19 pandemic lockdown.

MATERIALS AND METHODS

Retrospective analyses of renal colic, hematuria, and urinary retention in ER's admissions of a tertiary hospital during the lockdown period (March 19 to May 4, 2020) in Israel. Patient's demographics and clinical characteristics were compared to those in corresponding periods during 2017-2019, with estimated changes in ER arrival and waiting times, utilization of imaging tests, numbers of hospitalizations, and urgent procedure rates.

RESULTS

The number of ER visits for renal colic, hematuria, and urinary retention decreased by 37%, from an average of 451 (2017-2019) to 261 patients (2020). Clinical severity was similar between groups, with no major differences in patient's age, vital signs, or laboratory results. The proportion of ER visits during night hours increased significantly during lockdown (44.8% vs. 34.2%, p=0.002). There was a decrease in renal colic admission rate from 19.8% to 8.4% (p=0.001) without differences in urgent procedures rates, while the 30-day revisit rate decreased from 15.8% to 10.3% during lockdown (p=0.02).

CONCLUSIONS

General lockdown was accompanied by a significant decrease in common urological presentations to the ER. This change occurred across the clinical severity spectrum of renal colic, hematuria, and urinary retention. In the short term, it appears that patients who sought treatment did not suffer from complications that could be attributed to late arrival or delay in treatment. The long-term implications of abstinence from seeking emergent care are not known and require further investigation.

The clinical impact of the COVID-19 pandemic on daily urological practice: first 3-month multicenter results from İstanbul

BACKGROUND/AIM

The aim of this paper was to determine the general tendencies of urology patients and effect of COVID-19 pandemic on daily urological practice at tertiary centers located in the most affected area in Turkey.

MATERIALS AND METHODS

We retrospectively analyzed the data of 39,677 patients (group 1) that applied to 6 different large-volume tertiary centers in İstanbul for outpatient consultation, surgery, or other procedures in the 3-month period between March 16 and June 14, 2020. The distribution of the number of patients who applied to subspecialty sections of urology outpatient clinics and inpatient services were recorded by weeks. That data was compared to data obtained from 145,247 patients that applied to the same centers in the same period of the previous year (group 2). The reflection of worldwide and Turkish COVID-19 case distribution on the daily urological practice was analyzed.

RESULTS

There was a decrease in the number of patients in all subspecialty sections the in group 1 compared to group 2; however, there was a significant proportional increase in urooncology and general urology admissions. A decrease of approximately 75% was observed in the total number of surgeries (p < 0.001). We detected a negative correlation between the numbers of admission to all outpatient clinics and COVID-19 cases or deaths in Turkey (p < 0.05). The same negative correlation was present for all surgical procedures and consultations (p < 0.05). The multivariate linear regression analysis revealed that the number of cases in Turkey, and the number of deaths worldwide affect the number of outpatient clinic admissions (R2 = 0.38, p = 0.028) and urological surgery (R2 = 0.33, p = 0.020) in Turkey negatively.

CONCLUSION

This novel pandemic has implications even for urology practice. Urological surgical procedures were more affected by COVID-19-related deaths in Turkey and worldwide. Outpatient admissions and urological surgeries decreased significantly by increasing COVID-19 case numbers in Turkey and worldwide deaths.

An Italian multicenter analysis of emergency admissions and treatment of upper tract urolithiasis during the lockdown and reopening phases of the COVID-19 pandemic: Are we ready for a second wave of the outbreak?

OBJECTIVES

To assess if the lockdown period (March-April 2020) during the coronavirus disease-19 outbreak in Italy influenced the number, presentation, and treatment of urgent admissions to the emergency department for ureteral lithiasis, and to evaluate the same variables during the reopening phase (May-June 2020).

METHODS

We performed a retrospective analysis of patients admitted to the emergency department of three different hospitals (two coronavirus disease-19 hubs). Demographics and data on acute pyelonephritis, acute kidney injury, urinoma, hematuria, inpatient admission/discharge home, and type of treatment were gathered and compared with the same periods in 2019.

RESULTS

A total of 516 patients were admitted during the study period, of whom 62.4% were male. Their mean age was 58.86 ± 16.24 years. The number of admissions decreased significantly, by 51.25% (P = 0.003), during lockdown compared to 2019 (78 vs 160 admissions). The number of admissions in the reopening phase (May-June 2020) was in line with that in 2019 (n = 138). The number of hospitalizations (P = 0.005), acute obstructive pyelonephritis (P = 0.019), and complications (P = 0.02) was statistically significantly higher during lockdown compared to 2019. The increase in the rate of surgical procedures nearly reached significance (P = 0.059). The odds of having complications and being hospitalized were almost fivefold (odds ratio 4.68, 95% confidence interval 1.98-11.07) and twofold greater (odds ratio 2.39, 95% confidence interval 1.29-4.43) compared to the same period in 2019. No difference was noted between May-June 2020 and 2019.

CONCLUSION

The coronavirus disease-19 lockdown period provoked a meaningful reduction in symptomatic ureteral lithiasis admission. Most patients presented with complicated disease, which required an increased rate of interventional procedures compared to the equivalent period in 2019. Admissions reverted to normal levels during the reopening phase.

Nation-wide analysis of the impact of Covid-19 pandemic on daily urology practice in Turkey

OBJECTIVE

To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic.

METHODOLOGY

The centres participating in the study were divided into three groups as tertiary referral centres, state hospitals and private practice hospitals. The number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. The weekly change of the workload of urology during pandemic period was evaluated, also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019.

RESULTS

A total of 51 centres participated in the study. The number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the 3rd week of pandemics in state hospitals and tertiary referral centres; however, the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared, a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared with normal life.

CONCLUSIONS

Covid-19 pandemic significantly affected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines.

Decision making and treatment options in endourology post-coronavirus disease 2019 - adapting to the future

PURPOSE OF REVIEW

To describe and critically discuss the most recent evidence regarding stone management during the coronavirus disease 2019 (COVID-19) and post-COVID-19 era.

RECENT FINDINGS

There is a need to plan for resuming the normal elective stone surgery in the post-COVID era, keeping a clear record of all surgeries that are being deferred and identifying subgroups of surgical priorities, for the de-escalation phase. Telehealth is very useful because it contributes to reduce virus dissemination guaranteeing at the same time an adequate response to patients' care needs. Once the pandemic is over, teleurology will continue to be utilized to offer cost-effective care to urological patients and it will be totally integrated in our clinical practice.

SUMMARY

This COVID-19 pandemic represents a real challenge for all national health providers: on the one hand, every effort should be made to assist COVID patients, while on the other hand we must remember that all other diseases have not disappeared in the meanwhile and they will urgently need to be treated as soon as the pandemic is more under control. A correct prioritization of cases when surgical activity will progressively return back to normality is of paramount importance.

The impact of delaying acute kidney stone surgery on outcomes

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Urolithiasis treatment options during COVID-19 pandemic: review of current recommendations and triage systems

BACKGROUND

COVID-19 pandemic has overwhelmed healthcare systems and limited access to surgical care. Urolithiasis can lead to emergencies and affect renal function during long-term follow-up. Therefore, timely and appropriate treatment is essential.

MAIN TEXT

This is a non-systematic review of the recently published recommendations regarding urolithiasis treatment options during COVID-19. Fourteen publications were the basis of our review. Regarding anesthesia methods, the optimal methods are still unknown. During COVID-19, most of the endo-urologists changed their routine clinical practice and elective surgical treatment approaches. Despite decreasing number of emergency visits and admissions for stone disease, patients tend to have leukocytosis, higher creatinine levels, increased grade 3 and 4 hydronephrosis, and higher incidence of complications compared to non-COVID-19 time. Several alarming indications if present, intervention should be performed within 24 h to prevent irreversible kidney damage, disease progression, or even death. Some endo-urologists prefer definitive stone treatment over temporarily drainage to reduce the number of emergency room visits and hospital admissions, except if infection is present or staged treatment is planned. Several clinical scenarios of non-emergency and non-urgent urinary stones are present; thus, endo-urologists should appropriately weigh patient's risk and surgery benefit to decide to the proper intervention time. If risks outweighed benefits to the patient, postpone the surgery. Renal colic should be managed with medical expulsive therapy and proper pain control with close follow-up just in case it becomes an emergency. Indwelling JJ stent removal or exchange is a matter of debate; some endo-urologists recommend removing, while others recommend postponing.

CONCLUSION

Treatment options for urinary stones have markedly changed during COVID-19 pandemic. The optimal anesthesia methods are still unknown. Emergency intervention is a must if any alarming indications exist. Emergency cases tend to have higher incidence of complications compared to non-COVID-19 time. For non-emergency and non-urgent urolithiasis, endo-urologists should make judicious treatment decision to prioritize urolithiasis treatment, and they should weigh benefits and risks before surgery.