Impact of COVID-19 on the management of ureteric stones in the UK: the COVID Stones study

Introduction: In the COVIDStones study, we aimed to determine how management of ureteric stones changed during the COVID-19 pandemic in the United Kingdom. Materials and Methods: The COVID Stones study was a multi-centre retrospective study of consecutive adults diagnosed with CT-proven ureteric stone disease at 19 UK sites. We compared a pre-pandemic period (23/3/19 to 22/6/19) to a period during the pandemic (the 3-month period after the first SARS-CoV-2 case at individual sites). Results: 3755 patients were included (pre-pandemic = 1963 patients;pandemic = 1792 patients). Patients during the pandemic had significantly lower hospital admission rates (pre-pandemic = 54.2% vs pandemic = 46.6%, p<0.001), shorter length of stay (mean = 4.0 vs. 3.2 days, p=0.01), and higher rates of use of alpha-blockers (16.1% vs. 23.3%, p<0.001). In the cohort of patients who received interventional management (n=790 [44.1%] vs. n=686 [34.9%]), rates of ESWL (22.8% vs. 33.9%, p<0.001) were significantly higher;rates of ureteroscopy (56.7% vs. 47.7%, p<0.01) and stent insertion (67.9% vs. 54.5%, p>0.001) were lower;and there was no difference in rates of nephrostomy (p=0.76) during the pandemic. During the pandemic, there was no difference in success of primary treatment overall, including both non-interventional and interventional modalities (prepandemic= 73.8% vs. pandemic=76.2%, p=0.467), nor when stratified by treatment modality or stone size. Conclusions: Despite fewer invasive procedures performed during the pandemic, we demonstrated no difference in success of treatment, without an increase in adverse outcomes. This leads us to question whether the management of ureteric stones can be optimised further.

Upper urinary tract stones: Evolution of surgical management trends in Germany, France and England over the past decade

Introduction & Objective: Global Upper Urinary Tract (UUT) stone prevalence is rising. As a consequence, the increased service demand on hospitals may be difficult to manage, increasing the burden on healthcare providers (HCPs) as well as on patients. In this European analysis we explore the evolution of stone diagnoses and surgical procedures in Germany (DE), France (FR), and England (EN) over the past ten years. Methods: We identified the codes related to UUT stones diagnoses using the International Classification of Diseases (ICD-10) and extracted procedure counts for Extracorporeal Shock Wave Lithotripsy (ESWL), Ureteroscopy (URS), Percutaneous Nephrolithotomy (PCNL) and Open Surgery (OS). We used procedure codes from the National databases in DE, FR and EN, and analyzed the hospital diagnosis counts versus surgical procedure counts related to UUT stones from 2010 to 2019. Results: Between 2010-2019, the ICD-10 N20 codes for calculus of kidney and ureter increased by 8%;26% and 15% in DE, FR, EN respectively, whereas stone procedures increased by 3%;38% and 18%. Over time the dominant surgical UUT stone procedure shifted from ESWL (49-60% of all procedures in 2010) to URS (51-75% of all procedures in 2019). PCNL and OS represent <5% of UUT stones procedures in FR and EN. The highest use of PCNL is observed in DE (increase from 7% in 2010 to 11% in 2019). Over the past decade, the overall length of stay (LoS) decreased for all procedures across the three countries. The URS average LoS decreased by 21% in DE;37% in FR and 6% in EN. Daycase stone procedures volume increased in FR by 68% and in EN by 23%. In DE most cases involve at least one overnight stay. Conclusions: This analysis confirms the rise in stone prevalence globally, including an increase in UUT stones diagnoses and surgical procedures in DE, FR, EN over the past decade. The dominant surgical procedure to treat UUT stone has shifted from ESWL to URS, and the average LoS has decreased. These observed trends may be due to clinical advantages, technological advancement as well as, other factors such as HCP preference or costs. The continued rise of UUT stone prevalence has implications for patients, HCPs and hospitals. If we add to that the COVID19 repercussions, solutions to optimize workforce planning, service delivery and length of stay could help to address the situation.

Efficacy and safety of the EMS Swiss LithoClast® Trilogy for PCNL: results of the European multicentre prospective study on behalf of European Section of UroTechnology.

PURPOSE: PCNL requires a lithotrite to efficiently break stones, and some devices include active suction to remove the fragments. We set out to determine the efficacy and safety of the Swiss LithoClast® Trilogy, in a prospective European multicentre evaluation and compared it to published stone clearance rates for Trilogy based on surface area (68.9 mm2/min) and using the 3D calculated stone volume (526.7 mm3/min). METHODS: Ten European centres participated in this prospective non-randomized study of Trilogy for PCNL. Objective measures of stone clearance rate, device malfunction, complications and stone-free rates were assessed. Each surgeon subjectively evaluated ergonomic and device effectiveness, on a 1-10 scale (10 = extremely ergonomic/effective) and compared to their usual lithotrite on a 1-10 scale (10 = extremely effective). RESULTS: One hundred and fifty seven PCNLs using Trilogy were included (53% male, 47% female; mean age 55 years, range 13-84 years). Mean stone clearance rate was 65.55 mm2/min or 945 mm3/min based on calculated 3D volume. Stone-free rate on fluoroscopy screening at the end of the procedure was 83%. Feedback for suction effectiveness was 9.0 with 9.1 for combination and 9.0 for overall effectiveness compared to lithotrite used previously. Ergonomic score was 8.1, the least satisfactory element. Complications included 13 (8.2%) Clavien-Dindo Grade II and 2 (1.3%) Grade III. Probe breakage was seen in 9 (5.7%), none required using a different lithotrite. CONCLUSIONS: We have demonstrated that Trilogy is highly effective at stone removal. From a user perspective, the device was perceived by surgeons to be highly effective overall and compared to the most commonly used previous lithotrite, with an excellent safety profile.

The COVID stones collaborative: How has the management of ureteric stones changed during and after the COVID-19 pandemic? Rationale and study protocol

Background and objectives The coronavirus disease 2019 (COVID-19) pandemic is having a significant impact on healthcare delivery. As a result, management of patients with ureteric stones has likely been affected. We report our study protocol for the investigation of ureteric stone management during and after the COVID-19 pandemic. Material and methods The COVID Stones study is a multicenter national cohort study of the management and outcomes of patients with ureteric stones before, during, and after the COVID-19 pandemic in the United Kingdom. The study will consist of three data collection periods, pre-pandemic (“pre-COVID”), pandemic (“COVID”), and postpandemic (“post-COVID”). This will allow quantification of what “normal” was, how this has changed, and to capture any persisting changes in management. The primary outcome evaluating the success rate of the initial treatment decision will be assessed following a 6-month follow-up from the time of first presentation and will be performed for each recruited patient from each of the three data collection periods. This will allow comparison between both management and outcomes before, during, and after the pandemic. Conclusions We anticipate that this study will lead to an increased understanding of the impact of the outcomes of emergency management of ureteric stones following changes in clinical practice due to the COVID-19 pandemic health provision restrictions.