Urolithiasis treatment options during COVID-19 pandemic: review of current recommendations and triage systems

Abstract

Background COVID-19 pandemic has overwhelmed healthcare systems and limited access to surgical care. Urolithiasis can lead to emergencies and affect renal function during long-term follow-up. Therefore, timely and appropriate treatment is essential. Main text This is a non-systematic review of the recently published recommendations regarding urolithiasis treatment options during COVID-19. Fourteen publications were the basis of our review. Regarding anesthesia methods, the optimal methods are still unknown. During COVID-19, most of the endo-urologists changed their routine clinical practice and elective surgical treatment approaches. Despite decreasing number of emergency visits and admissions for stone disease, patients tend to have leukocytosis, higher creatinine levels, increased grade 3 and 4 hydronephrosis, and higher incidence of complications compared to non-COVID-19 time. Several alarming indications if present, intervention should be performed within 24 h to prevent irreversible kidney damage, disease progression, or even death. Some endo-urologists prefer definitive stone treatment over temporarily drainage to reduce the number of emergency room visits and hospital admissions, except if infection is present or staged treatment is planned. Several clinical scenarios of non-emergency and non-urgent urinary stones are present; thus, endo-urologists should appropriately weigh patient’s risk and surgery benefit to decide to the proper intervention time. If risks outweighed benefits to the patient, postpone the surgery. Renal colic should be managed with medical expulsive therapy and proper pain control with close follow-up just in case it becomes an emergency. Indwelling JJ stent removal or exchange is a matter of debate; some endo-urologists recommend removing, while others recommend postponing. Conclusion Treatment options for urinary stones have markedly changed during COVID-19 pandemic. The optimal anesthesia methods are still unknown. Emergency intervention is a must if any alarming indications exist. Emergency cases tend to have higher incidence of complications compared to non-COVID-19 time. For non-emergency and non-urgent urolithiasis, endo-urologists should make judicious treatment decision to prioritize urolithiasis treatment, and they should weigh benefits and risks before surgery.

The development and application of a triage system for urolithiasis during COVID-19

“…A recent review by Abdel et al synthesized the published recommendations and triage systems (n = 14) in urology. [4] The included literature indicates that 4 previous studies made triage suggestions specifically for urinary stones. Regarding the level of triage, Proietti et al [5] and Ian et al [7]recommended four-and five-level prioritization schemes, respectively, while Fakhr et al and [27] Almeras et al [28] used three levels.…”

“…According to the guidelines and literature review, [4,[9][10][11][12] we used examination, extract and cluster strategies to identify three common contributors to the prognosis of urolithiasis to form the basic framework: obstruction, infection, and kidney dysfunction. The priority of a patient depends not only on the degree of these factors but also on their mutual effects.…”

“…[3] There are also some recommendations specifically for the triage of urinary stones. [4][5][6][7] In these suggestions, many indications have been used to assess the urgency of diseases, such as stone size, obstruction, renal colic, infection, indwelling J-J stents, and kidney dysfunction. These rapid responses have greatly optimized urolithiasis practices.…”

“…[8] A recent systematic review by Abdel et al stated that the optimal triage system for urolithiasis is still unknown. [4] The study aims to develop a triage system for urolithiasis based on a physiopathological framework of disease and to report on its usage in clinical practice during the COVID-19 crisis in our institution in 2020.…”

The characteristics and influencing factors of fever in postoperative patients undergoing percutaneous nephrolithotomy

“…[ 2 ] Different countries have different prevalence of urinary stones with regards to different races, climates, socioeconomic conditions, education levels, eating habits, and other factors. [ 3 , 4 ] According to reports, [ 5 , 6 ] the prevalence of urinary stones in China is between 4.11% and 6.4%. The existence of stones will have many adverse effects on the human body.…”