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

Abstract

Purpose To review the existing available information regarding urolithiasis management and the impact of COVID-19 on this, and propose recommendations for management of emergency urolithiasis presentations in the COVID-19 era. Methods Review of published guidelines produced by Urological Governing Bodies, followed by the literature review regarding urolithiasis management during the COVID-19 pandemic. Results Consistent recommendations across guidelines and literature were that urolithiasis with concurrent sepsis or renal failure remains a urological emergency warranting urgent intervention within the pandemic environment. Ureteric stenting and percutaneous nephrostomy are considered equivalent for decompression in this setting, with both ideally to be performed under local anaesthesia where possible to spare ventilators and reduce aerosol-generating procedures. Greater utilization of medical expulsive therapy and dissolution chemolysis may occur during the pandemic, and longer indwelling stent times may be accepted while definite stone clearance is deferred. Conclusions Urolithiasis will continue to be a source of emergency presentations requiring urgent intervention during the COVID-19 pandemic. However, it is possible to limit these interventions to decompression of the collecting system in the setting of concurrent obstruction or infection, performed under local anaesthesia to limit use of resources and minimise aerosol-generating procedures, with deferral of definitive management.

The impact of COVID 19 pandemic on urology literature: a bibliometric analysis

“…Numerous studies focused on prioritization strategies for oncological or non-oncological procedures and produced general recommendations for deferring treatment or resumption of elective surgeries [ 2 , 18 – 23 ]. Several authors described the adverse outcomes of delaying emergent cases of urinary stones and drew up guidelines for perioperative evaluation and treatment choice [ 24 , 25 ]. The oncological and functional risk of treatment deferral for intermediate and high risk prostate cancer patients has been extensively studied [ 26 ].…”

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

“…Many patients with urolithiasis could require management during the COVID-19 pandemic and this is likely to limit surgical procedures to those requiring urgent decompression in the context of obstruction and/or infection 25 . MET and chemolysis are two useful management strategies for these patients who do not need for urgent and non-delayable procedures.…”

After COVID-19: planning postpandemic care of patients with kidney stones

“…Most urological guidelines suggested short-term modifications in their strategies for managing kidney stone disease during the COVID-19 pandemic, with possible deferral of definitive stone procedures and acceptance of increased indwelling stent time 4 . However, infected obstructed kidneys would still need urgent decompression, with the preferred choice of treatment being a ureteric stent or percutaneous nephrostomy under a local anaesthetic.…”