Endourology (Lithiasis). Management, surgical considerations and follow-up of patients in the COVID-19 era

Abstract

Purpose: To provide recommendations on the endourological management of lithiasis in the scenario of the COVID-19 pandemic. Materials and Methods: A non-systematic review in PubMed and the grey literature, as well as recommendations by a panel of stakeholders was made, regarding management, surgical considerations and follow-up of patients affected by lithiasis in the COVID-19 era. Results: Under the current outbreak and COVID-19 pandemic scenario, patients affected by lithiasis should be prioritized into low, intermediate and high risk categories, to decide their delay and save resources, healthcare personnel, beds and ventilators. However, patients with potentially serious septic complications need emergency interventions. The possibility of performing or restarting elective activity depends on local conditions, the availability of beds and ventilators, and the implementation of screening protocols in the context of the COVID-19 pandemic. Delaying lithiasis surgery and increasing waiting lists will have consequences and will require considerable additional effort. Teleconsultation may be useful in guiding these patients, reducing visits and unnecessary exposure. Conclusions: categorization and prioritization of patients affected by lithiasis is crucial for management, surgical selection and follow-up. Protocols, measures and additional efforts should be carried out in the current situation of the COVID-19 pandemic.

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

“…In accordance with the recommendations, the numbers of elective surgeries (URS and PNL) for urolithiasis, benign prostatic diseases and endoscopic urethrotomies have decreased and the rates of temporary measures such as ureteral stenting, nephrostomy placement and percutaneous cystostomy as emergent interventions have increased during pandemic period in our study. This reflects to the adaptation of urologic surgeons in our country to the published recommendations 7,20,22 …”

“…Cancellation of elective surgeries for urolithiasis, benign prostatic hyperplasia and urethral strictures were recommended in pandemic period 7 . If there is an obstruction in upper urinary tract, the ureteral stenting or nephrostomy tube placement are recommended instead of definitive treatments 7,20,21 . The EULIS Collaborative Research Working Group published the results of a survey related with routine practice of endourologists in stone diseases during the Covid‐19 pandemic 22 .…”

“…7 If there is an obstruction in upper urinary tract, the ureteral stenting or nephrostomy tube placement are recommended instead of definitive treatments. 7,20,21 The EULIS Collaborative…”

“…This reflects to the adaptation of urologic surgeons in our country to the published recommendations. 7,20,22 The healthcare institutions have to prepare strategies to increase bed resources and availability for Covid-19 patients. The main measures for this process include, performing the triage in outpatient clinics to decrease other types of admissions and decreasing the number and length of hospital stay.…”

Prioritization of risk situations in neuro-urology: guidelines from Association Française d’Urologie (AFU), Association Francophone Internationale des Groupes d’Animation de la Paraplégie (A.F.I.G.A.P.), Groupe de Neuro-urologie de Langue Française (GENULF), Société Française de Médecine Physique et de Réadaptation (SOFMER) and Société Interdisciplinaire Francophone d’UroDynamique et de Pelvi-Périnéologie (SIFUD-PP)

“…To the best of our knowledge, the present work provides the first grading risk-situation guidelines in patients with NLUTD. In the existing guidelines established when the COVID-19 pandemic started, patients with NLUTD were barely considered, and often lumped together with functional urology, which was not considered as an emergency condition by a few scientific societies [ 7 , 15 – 17 ]. Only the EAU [ 18 , 19 ], the AFU [ 5 ], and the ICS[ 20 ] described the neurologic population and suggested a management schedule for these patients in times of health crisis.…”