Consensus of multiple national guidelines: agreed strategies for initial stone management during COVID-19

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.

Consensus Statement on Urinary Stone Treatment During A Pandemic: A Delphi Process from the Endourological Society TOWER Research Initiative

INTRODUCTION

The COVID-19 pandemic has had a significant impact on the care of patients with urolithiasis. Recommendations and prioritization of endourologic surgical procedures vary among regions and a comprehensive overall international directive is needed. We used the Delphi method to obtain international consensus on managing urolithiasis patients during the pandemic.

METHODS

A three-round Delphi process was used to elicit expert consensus (53 global key opinion leaders within the Endourological Society from 36 countries) on an extensive survey on management of endourologic patients in a pandemic. Questions addressed general management, inpatient and outpatient procedures, clinic visits, follow-up care and best practices for suspension and resumption of routine care.

RESULTS

Consensus was achieved in 64/84 (76%) questions. Key consensus findings included: consultations should be delivered remotely when possible. Invasive surgical procedures for urolithiasis patients should be reserved for high-risk situations (infection, renal failure, etc.). To prevent aerosolization, spinal anesthesia is preferred over general, whenever feasible. Treatment of asymptomatic renal stones should be deferred. Primary definitive treatment of obstructing or symptomatic stones (both renal and ureteral) is preferred over temporizing drainage. Extracorporeal shock wave lithotripsy should be continued for obstructive ureteral stones. There was consensus on treatment modalities and drainage strategies depending on location and size of the stone.

CONCLUSION

International endourologist members of the Endourological Society participated in this Delphi initiative to provide expert consensus on management of urolithiasis during a pandemic. These results can be applied currently and during a future pandemic.