An Italian multicenter analysis of emergency admissions and treatment of upper tract urolithiasis during the lockdown and reopening phases of the COVID‐19 pandemic: Are we ready for a second wave of the outbreak?

Abstract

Objectives: To assess if the lockdown period (March-April 2020) during the coronavirus disease-19 outbreak in Italy influenced the number, presentation, and treatment of urgent admissions to the emergency department for ureteral lithiasis, and to evaluate the same variables during the reopening phase (May-June 2020). Methods: We performed a retrospective analysis of patients admitted to the emergency department of three different hospitals (two coronavirus disease-19 hubs). Demographics and data on acute pyelonephritis, acute kidney injury, urinoma, hematuria, inpatient admission/discharge home, and type of treatment were gathered and compared with the same periods in 2019. Results: A total of 516 patients were admitted during the study period, of whom 62.4% were male. Their mean age was 58.86 AE 16.24 years. The number of admissions decreased significantly, by 51.25% (P = 0.003), during lockdown compared to 2019 (78 vs 160 admissions). The number of admissions in the reopening phase (May-June 2020) was in line with that in 2019 (n = 138). The number of hospitalizations (P = 0.005), acute obstructive pyelonephritis (P = 0.019), and complications (P = 0.02) was statistically significantly higher during lockdown compared to 2019. The increase in the rate of surgical procedures nearly reached significance (P = 0.059). The odds of having complications and being hospitalized were almost fivefold (odds ratio 4.68, 95% confidence interval 1.98-11.07) and twofold greater (odds ratio 2.39, 95% confidence interval 1.29-4.43) compared to the same period in 2019. No difference was noted between May-June 2020 and 2019. Conclusion:The coronavirus disease-19 lockdown period provoked a meaningful reduction in symptomatic ureteral lithiasis admission. Most patients presented with complicated disease, which required an increased rate of interventional procedures compared to the equivalent period in 2019. Admissions reverted to normal levels during the reopening phase.

Impact of COVID‐19 on the management and outcomes of ureteric stones in the UK: a multicentre retrospective study

“…Castellani et al. [26] compared ureteric stone disease outcomes of 298 patients prior to the pandemic with 218 patients during the pandemic, reporting reduced admissions and higher rates of infected‐obstructed systems, hospitalisation, and intervention during the COVID‐19 pandemic. Furthermore, Flammia et al.…”

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

“…The number of admissions in the reopening phase (May-June 2020) was in line with that in 2019 (n = 138). However, the frequency of hospitalizations, acute obstructive pyelonephritis and complications was significantly higher during lockdown compared to 2019 22 . In contrast, our work revealed that the whole number of elective and urgent surgical procedures were similar.…”

Urological stone disease: a 5‐year update of stone management using Hospital Episode Statistics

“…A similar analysis was conducted in Italy during the lockdown period between March and April 2020, showing a significant reduction in symptomatic ureteral lithiasis admission of 51.2%. Most of the patients hospitalized had complicated disease and required an increased rate of interventional procedures compared to the equivalent period in 2019 [29]. Patients presenting with renal colic preferred oral analgesics over SWL and i.v.…”