Has the SARS-CoV-2 Pandemic Improved the Management of Acute Ureteric Colic?
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Abstract
Objective
The WHO declared SARS-CoV-2 a pandemic on 11th March 2020 prompting a rapid change to surgical practice. This study focuses on how the management of ureteric colic has adapted in a major tertiary referral unit during the peak of the pandemic so that lessons be can be learned in case a second wave occurs. Materials and
Methods
We compared admission rates and treatment patterns against national and European guidelines in 20 weeks, divided into pre- and peri-pandemic.
Results
A total of 72 patients were admitted during the study period. 64% (46/72) were admitted pre-pandemic. 22% (10/46) of these were septic (5 stented, 5 nephrostomized) while 20% (9/46) were managed conservatively. 59% (27/46) of pre-pandemic admissions were suitable for active treatment, of which 48% (13/27) received definitive treatment (11 ureteroscopy (URS), 2 shockwave lithotripsy (SWL)) all within 48 hours of admis-sion. 52% (14/27) had temporising procedures (11 stented, 3 nephrostomized) and underwent definitive treatment within 63 days.
Of the total patients, 36% (26/72) were admitted peri-pandemic. 23% (6/26) were septic (1 stent, 5 nephrostomized), while 31% (8/26) were managed conservatively. 46% (12/26) were suitable for active treatment. 75% (9/12) received definitive treatment (4 URS, 5 SWL) of which 33% (4/12) within 48 hours and the remaining treated and stone free within 12 days. 25% (3/12) had temporising procedures (2 stented, 1 nephrostomized), with the definitive treatment provided within 17 days.
Conclusion
Ureteric colic admissions were reduced by almost half during the pandemic. There has been increased primary treatment with a reduction in temporising procedures and time to receiving definitive treatment. In the ‘new normal,’ lessons learned must be carried forward to maintain high rates of definitive treatments.
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References
2. Wosik J, Fudim M, Cameron B, Gellad ZF, Cho A, Phinney D, et al. Telehealth Transformation: COVID-19 and the rise of Virtual Care. J Am Med Inform Assoc. 2020 Apr.
3. NICE. Renal and ureteric stones: assessment and management [Internet]. 2019. Available at: https://www.nice.org.uk/guidance/ng118/chapter/Recommendations
4. EAU. Urolithiasis. 2020; Available at: https://uroweb.org/guideline/urolithiasis/#note_112
5. Kumar A, Mohanty NK, Jain M, Prakash S, Arora RP. A prospective randomized comparison between early (<48 hours of onset of colicky pain) versus delayed shockwave lithotripsy for symptomatic upper ureteral calculi: a single center experience. J Endourol. 2010 Dec;24(12):2059–66.
6. Zargar-Shoshtari K, Anderson W, Rice M. Role of emergency ureteroscopy in the management of ureteric stones: analysis of 394 cases. BJU Int. 2015 Jun;115(6):946–50.
7. Ghoneim IA, El-Ghoneimy MN, El-Naggar AE, Hammoud KM, El-Gammal MY, Morsi AA. Extracorporeal shock wave lithotripsy in impacted upper ureteral stones: a prospective randomized comparison between stented and non-stented techniques. Urology. 2010 Jan;75(1):45–50.
8. Getting It Right First Time. GIRFT Urology National Speciality Report [Internet]. 2018. Available at: https://gettingitrightfirsttime.co.uk/wp-content/uploads/2018/07/GIRFT-Urology.pdf
9. Chew BH, Lange D. Ureteral stent symptoms and associated infections: a biomaterials perspective. Nat Rev Urol. 2009 Aug;6(8):440–8.
10. BAUS. BAUS COVID-19:Information for Members [Internet]. 2020. Available at: https://www.baus.org.uk/mybaus/covid19_members_information.aspx
11. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb;315(8):801–10.
12. Madanelo M, Ferreira C, Nunes-Carneiro D, Pinto A, Rocha MA, Correia J, et al. The impact of the COVID-19 pandemic on the utilization of emergency urological services. BJU Int. 2020 May;
13. Metzler B, Siostrzonek P, Binder RK, Bauer A, Reinstadler SJ. Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. Eur Heart J [Internet]. 2020 Apr 16;41(19):1852–3. Available at: https://doi.org/10.1093/eurheartj/ehaa314
14. Rudilosso S, Laredo C, Vera V, Vargas M, Renú A, Llull L, et al. Acute stroke care is at risk in the era of COVID-19: Experience at a comprehensive stroke center in Barcelona. Stroke. 2020 May;STROKEAHA120030329.
15. Giamello JD, Abram S, Bernardi S, Lauria G. The emergency department in the COVID-19 era. Who are we missing? Eur J Emerg Med Off J Eur Soc Emerg Med. 2020 Apr;
16. Lallas CD, Liu XS, Chiura AN, Das AK, Bagley DH. Urolithiasis location and size and the association with microhematuria and stone-related symptoms. J Endourol. 2011 Dec;25(12):1909–13.
17. Proietti S, Gaboardi F, Giusti G. Endourological stone management in the era of the COVID-19. European Urology. 2020.
18. Sun Y, Lei G-L, Yang L, Wei Q, Wei X. Is tamsulosin effective for the passage of symptomatic ureteral stones: A systematic review and meta-analysis. Medicine (Baltimore) [Internet]. 2019 Mar;98(10):e14796–e14796. Available at: https://pubmed.ncbi.nlm.nih.gov/30855496
19. Teo K-C, Leung WCY, Wong Y-K, Liu RKC, Chan AHY, Choi OMY, et al. Delays in stroke onset to hospital arrival time during COVID-19. Stroke. 2020 May;STROKEAHA120030105.
20. Tam C-CF, Cheung K-S, Lam S, Wong A, Yung A, Sze M, et al. Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on st-segment-elevation myocardial infarction care in Hong Kong, China. Vol. 13, Circulation. Cardiovasc Qual Outcomes. 2020; 006631.
21. Royal College of Surgeons (England). COVID-19: Good Practice for Surgeons and Surgical Teams [Internet]. 2020. Available at: https://www.rcseng.ac.uk/standards-and-research/standards-and-guidance/good-practice-guides/coronavirus/covid-19-good-practice-for-surgeons-and-surgical-teams/
22. Brubaker WD, Dallas KB, Elliott CS, Pao AC, Chertow GM, Leppert JT, et al. Payer type, race/ethnicity, and the timing of surgical management of urinary stone disease. J Endourol. 2019 Feb;33(2):152–8.
23. Tefik T, Guven S, Villa L, Gokce MI, Kallidonis P, Petkova K, et al. Urolithiasis practice patterns following the COVID-19 pandemic: Overview from the EULIS Collaborative Research Working Group. Eur Urol [Internet]. 2020 Apr 27;S0302-2838(20)30325-0. Available at: https://pubmed.ncbi.nlm.nih.gov/32362496
24. Stensland KD, Morgan TM, Moinzadeh A, Lee CT, Briganti A, Catto JWF, et al. Considerations in the triage of urologic surgeries during the COVID-19 Pandemic. Eur Urol. 2020;77: 663–6.
25. Ficarra V, Novara G, Abrate A, Bartoletti R, Crestani A, De Nunzio C, et al. Urology practice during COVID-19 pandemic. Minerva Urol Nefrol. 2020 Mar;
26. Stahel PF. How to risk-stratify elective surgery during the COVID-19 pandemic? Patient Safety Surg. 2020;14:8.
27. Vigneswaran Y, Prachand VN, Posner MC, Matthews JB, Hussain M. what is the appropriate use of laparoscopy over open procedures in the current COVID-19 climate? J Gastrointest Surg Off J Soc Surg Aliment Tract. 2020 Apr;1–6.
28. RCS. RCS-Joint Guidance for Surgeons [Internet]. Available at: https://www.rcseng.ac.uk/coronavirus/joint-guidance-for-surgeons-v2/
29. Papalia R, Cataldo R, Alloni R, Pang KH, Alcini A, Flammia G, et al. Urologic surgery in a safe hospital during the COVID-19 pandemic scenario. Minerva Urol Nefrol. 2020 Jun;
30. Simonato A, Giannarini G, Abrate A, Bartoletti R, Crestani A, De Nunzio C, et al. Clinical pathways for urology patients during the COVID-19 pandemic. Minerva Urol Nefrol. 2020 Jun;72(3):376–83.