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
Introduction: To demonstrate safety of a new internal protocol for patients and health workers adopted for elective urologic surgical activity during COVID-19 pandemic. Materials and methods: We have retrospectively evaluated 86 patients who underwent elective surgery in the urology department of IRCCS Policlinico San Donato, from March 9th to May 8th, 2020. Our institution became a first line hospital for COVID-19 patients since March 2020. We identified non-deferrable patients that needed to be treated within one month. All patients included have followed a dedicated pathway from the day-hospital till the discharge. Clinical data, as nasopharyngeal swabs, chest X-ray, type of anesthesia, type of surgical procedure and days of hospitalization were collected. Moreover, individual risk factors for COVID-19 pneumonia, as advanced age, ongoing malignancy, high blood pressure and coronary artery disease, were analyzed. All patients were interviewed after a minimum post discharge time of 14 days to find out if any of them had developed general and Covid-related complications. Results: The study population included 66 (76.75%) men and 20 (23.25%) women, aged between 17 and 90 years old. We have performed eighty-eight (88) preoperative screenings and two (2) patients were excluded, due to exclusion criteria. Overall, 63 (71.60%) patients underwent oncological procedures while only 23 (28.40%) patients underwent non-oncological surgery. The average number of hospitalization days was 2.39 ± 2.21. After at least 14 days after discharge (25.00 ± 10.35 days), we phone interviewed all patients to check their conditions. No patients included in the study showed symptoms related to COVID-19, except for 2 (2.32%) who manifested coryza, 28 and 35 days after discharge respectively. We also analyzed clinical characteristics of the study participants in relation to develop SARS CoV-2. None of patient developed Covid-19 postoperatively and in addition, none of hospital workers that were part of this pathway got the Covid-19 infection. Conclusions: The duration of pandemic period is undefined;therefore, our protocol could be considered a good model for every type of surgery and its application could ensure a continuous treatment for non-deferrable conditions, even during healthcare emergencies in a safe way for both the patients and health workers.
ABSTRACT
Although the incidence is uncertain, some case reports suggest that COVID 19 infection is associated with an increased risk of venous thromboembolism. We suggest starting prophylactic anticoagulant therapy for all patients hospitalized with a symptomatic infection with COVID-19, unless contraindicated, with enoxaparin 40 mg SC daily if creatinine clearance is greater than 30 ml/min.