ABSTRACT
Introduction & Objectives: The COVID-19 outbreak has brought challenges to the global healthcare community. The management of upper urinary tract stones has been affected even further, with potential severe sequelae for patient’s health.Materials & Methods: We report a multicentric retrospective study involving 9 Centers regularly delivering treatment for upper tract urinary stonesacross the country. All Centers suffered significant limitations during the pandemic period due to government limitations. We compared the 12months-period prior to COVID-19 (from march 1st 2019 to February 28th 2020, named as period A) with post-COVID-19 period (from march 1st,2020 to February 28th, 2021 named as period B). Aim of the study was to compare endourological procedures for upper urinary stones duringperiod A and the period B. This study investigated all types of surgeries for stones delivered in both elective and emergency setting.Results: A total of 4018 procedures were collected, including 2176 procedures in period A. In period B, 1842 procedures were carried out,corresponding to a loss of 15.35% of cases (p<0.001). Looking into elective cases, 1622 procedures were delivered in period A, compared to 1280in period B, resulting in a loss of 342 cases corresponding to 21.81% (p=0.001). All types of stone treatments resulted affected, including ESWL(from 487 cases in period A to 344 in period B, -29.37%, p=0.001), PCNLs (from 170 to 125 cases, corresponding to -26.47%, p:0.008), retrogradesurgery for renal stones (from 433 to 387 cases, -10.63%, p=0.008) and for ureteric stones (from 614 cases to 484, -21.18%, p.008). Additionally,waiting lists resulted affected, with significant delays in period B. In particular, for ureteric stones, mean waiting time in period A was 61.5 dayscompared to 87.5 days in period B (p=0.008). Regarding renal stones, waiting list increased from 64.74 days in period A to 85.66 days in periodB for RIRS. The waiting list for percutaneous surgeries increased from 79 days to 103 days (p.001). We did not find any patient which acquiredCOVID-19 during hospitalization for elective or urgent surgery. We also found a longer waiting list for pre-stented patients, resulting to be 86.5 daysin period B compared to 64 days in period A (p<0.005).Conclusions: Our study showed how COVID-19 caused a significant disruption in endourological services across the country. Our data underlined how less patients received treatment in a longer time. This can potentially lead to an increased risk of stone-related complications, including sepsis and kidney loss
ABSTRACT
Background: Patients affected by cancer are considered particularly susceptible to SARS-CoV-2 infection complications. We aimed to study the effect of COVID on patients with solid tumors at our Oncology Unit at Policlinico San Matteo of Pavia. Material and methods: Data of patients affected by solid tumors and COVID-19 were extracted from medical records between February 21, 2020 and May 15, 2021. COVID diagnosis was confirmed by RT-PCR on nasal swab. Associations between demographic, clinical characteristics and outcomes were measured with HR with 95%CI using Cox regression. Results: Seventy-five patients affected by solid tumors with COVID diagnosis were included in the analysis. The incidence of SARS-CoV-2 infection in our cancer patients was similar to that observed in the global Italian population (5.8 vs 6.2%), but lower compared to the local population of Lombardia (8.2%) and Pavia (7.9%). In 34 patients (45.9%) COVID diagnosis was obtained through screening, in 40 patients (54.1%) because of symptoms or radiologic findings. Median age was 64.4 years (25th-75th 56-75);the majority had an ECOG PS of 0-1 (89.2%), was affected by breast, lung or gastro-intestinal cancer (28.0, 26.7 and 21.3% respectively), had stage IV disease (72.2%) and was on therapy at the time of COVID (76.0%);26 patients (36.1%) were hospitalized;21 patients (28.0%) died, 13 of them (17.3%) for COVID complications. COVID determined a median delay of the oncologic treatment of 14.0 days (25th-75th 0-25). Mortality rate was higher in our cancer population than that observed in the global Italian population (3.0%), in local population of Lombardia (4.0%) and Pavia (5.9%). In the univariable analysis, being older than 66 years (HR: 2.64, 95%CI 1.06-6.55, p=0.029), with ECOG PS ≥ 2 (HR: 5.81, 95%CI 2.18-15.49, p=0.002), >1 comorbidities (HR: 2.72, 95%CI 1.14-6.48, p=0.023), having dyspnea at the time of COVID diagnosis (HR: 6.10, 95%CI 2.37-15.68, p=0.0001), and being hospitalized (HR: 6.75, 95%CI 3.06-36.89, p<0.001) were associated with increased risk of death. In multivariable analysis, ECOG PS ≥ 2, dyspnea, hospitalization and days of treatment delay were associated with increased risk of death. Conclusions: The incidence of SARS-CoV-2 infection in our cancer patients was lower than that observed in the local population of Lombardia and Pavia, while mortality rate was higher. Predictive factors of death in cancer population correlate consistently with those alrealy published about global population.