Impact of the COVID-19 Pandemic on Patient Preferences and Decision Making for Symptomatic Urolithiasis

Evaluation of fear, willingness to seek care, and healthcare delivery preferences for patients with nephrolithiasis during the COVID-19 pandemic

Background

Although minimal is known about coronavirus disease 2019 (COVID-19)'s impact on patient healthcare perceptions, improved understanding can guide healthcare providers to adequately address patient concerns. This cross-sectional study investigated how fear induced by COVID-19 impacted nephrolithiasis patients' perceptions, decision-making, and preferences for care delivery.

Methods

Utilizing the validated Fear of COVID-19 Scale (FCV-19S), patients were surveyed at a single stone clinic during part of the COVID-19 pandemic, 03/2021-04/2022. One-way analysis of variance (ANOVA), Chi-square tests, and multinomial logistic regression evaluated the effect of sociodemographics on responses.

Results

Two hundred and four surveys were completed. Mean age was 58±16 years, and 112 (54.9%) were women. Mean FCV-19S was 14.8±5.8 points (range, 7-33). Women and non-Caucasian races were associated with higher fear scores (P<0.01 and P=0.01 respectively). Stone prevention effort was not associated with fear (P=0.38). Poorer self-assessed health status was associated with increased stone prevention efforts (P=0.04). Preference for in-person care was reported in 89% of patients. Willingness to seek care varied by age and education, with decreased likelihood to seek care for middle-aged patients (P=0.04) and increased education (P=0.01).

Conclusions

Perceived fear during the COVID-19 pandemic was highly variable in nephrolithiasis patients, with higher fear scores in women and non-Caucasians. Willingness to seek care during the pandemic varied with age, education level, symptom severity, COVID-19 fear, current stone status, and health status. Stone patients greatly preferred in-person medical care over telemedicine during COVID-19. Future studies are needed to further evaluate these health disparities, discrepancies in fear, and comfort in seeking stone-related healthcare to help us better inform health policymakers and provide patient-centered care.

How has the COVID-19 pandemic changed treatment preferences of patients with proximal ureteral stones?

Background

The impact of the coronavirus disease 2019 (COVID-19) pandemic on patient decision making remains uncertain. This study aimed to investigate the effect of the pandemic on treatment preferences of patients with proximal ureteral stones.

Materials and methods

Retrospective data regarding treatment preferences of patients diagnosed with symptomatic proximal ureteral stones between July 2018 and November 2021 at a single center were analyzed. Data from 493 patients were analyzed according to 2 groups, including patients diagnosed during the COVID-19 pandemic and those diagnosed during an equivalent period of time before the pandemic.

Results

Preference for conservative treatment increased during the COVID-19 pandemic (p = 0.009). In patients who had previously undergone shock wave lithotripsy (SWL), the preference for SWL decreased and the preference for conservative treatment increased during the COVID-19 pandemic (p = 0.042). Multiple logistic regression analysis revealed a significant correlation between a preference for conservative treatment during the pandemic and no prior spontaneous stone passage (p = 0.003; odds ratio [OR], 2.48; 95% confidence interval [CI], 1.45-4.23), no hydronephrosis (p = 0.035; OR, 3.57; 95% CI, 1.34-9.49), and a visual analog scale score of 4 or less (p = 0.018; OR, 1.97; 95% CI, 1.15-3.38).

Conclusions

A significant increase in the preference for conservative treatment was observed among patients diagnosed during the pandemic, and patients with a history of SWL demonstrated a preference shift from SWL to conservative treatment.

Social Media and Apps in Urology

Purpose of Review

In this study, we aimed to review the common social media (SoMe) apps used and how they have impacted the practice and exchange of information, as well as the challenges of using SoMe in urology.

Recent Findings

SoMe has become increasingly popular in the urology community. Lay users often turn to SoMe to learn about urological health and share their own experiences, while medical professionals may use it for career development, networking, education, and research purposes.

Summary

It is important to recognize the power of SoMe and to use it responsibly and ethically, particularly given the potential risks of encountering low-quality or misleading information.

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.

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.

[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.

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.

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.

Does COVID-19 infection change the need for future surgical interventions? An exploratory analysis

Background: It is unknown whether recovery from coronavirus disease 2019 (COVID-19) infection leads to an increased need for common surgical procedures. Our objective was to conduct an exploratory analysis of surgical procedures performed after a documented COVID-19 infection.  Methods: We conducted a retrospective cohort study using routinely collected data from the province of Ontario, Canada. We identified individuals with a positive COVID-19 test between February 1 2020 and May 31 2020, and matched them 1:2 with individuals who had a negative COVID-19 test during the same period. We used physician billing codes to identify the ten most frequent surgical procedures in the COVID-19 cohort. An at-risk period 30 days after the first positive COVID-19 swab (or matched index date in the control group) until November 30 2020 was used. Cox proportional hazard models (adjusted for important baseline differences) are reported with hazard ratios (HR) and 95% confidence intervals.   Results: After exclusions and matching, we had 19,143 people in the COVID-19 cohort, and 38,286 people in the control cohort. The top ten surgical procedures were hand/wrist fracture fixation, cesarean-section, ureteral stent placement, cholecystectomy, treatment of an upper tract urinary stone, hysterectomy, femur fracture repair, hip replacement, transurethral prostatectomy, and appendectomy. There was a significantly reduced hazard of requiring upper tract renal stone surgery (adjusted hazard ratio [aHR] 0.50, 95% confidence interval [CI] 0.29-0.87) or ureteral stent placement (aHR 0.54, 95%CI 0.36-0.82), or undergoing a cholecystectomy (aHR 0.43, 95%CI 0.26-0.71) among those with a prior positive COVID-19 test.   Conclusions: After a COVID-19 infection there is not an increased risk of needing several common surgical procedures. There appears to be a reduced risk of renal stone disease treatment and ureteral stent placement, and a reduced risk of cholecystectomy, however understanding the reasons for this will require further study.

Changes in Urologic Operative Practice at the Beginning of the COVID-19 Pandemic in a Large, National Cohort

Objective

To analyze population-level changes in operative practice since the onset of the COVID-19 pandemic to contextualize observations made by individual practices and optimize future responses.

Materials and Methods

This US retrospective analysis used the Premier Perspectives Database. We investigated changes in operative volume through March 2020. Baseline operative volume for urologic surgery was calculated using data from the preceding 12 months and compared on a total and by procedure basis. Multivariable linear regression was used to identify hospital-level predictors of change in response to the pandemic.

Results

At baseline, we captured 23,788 urologic procedural encounters per month as compared with 19,071 during March 2020– a 19.9% decrease. Urologic oncology-related cases were relatively preserved as compared to others (average change in March 2020: +1.1% versus -32.2%). Northeastern (β = -5.66, 95% confidence interval [CI]: -10.2 to -1.18, p = 0.013) and Midwestern hospitals (β = -4.17, 95% CI: -7.89 to -0.45, p = 0.027; both with South as reference region), and those with an increasing percentage of patients insured by Medicaid (β= -0.17 per percentage point, 95% CI: -0.33 to -0.01, p = 0.04) experienced a significantly larger decrease in volume.

Conclusions

There was a 20% decline in urologic operative volume in March 2020, compared with baseline, that preferentially affected hospitals serving Medicaid patients, and those in Northeast and Midwest. In the face of varying mandates on elective surgery, widespread declines in operative volume may also represent hesitancy on behalf of patients to interface with healthcare during the pandemic.