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J Endourol ; 2020 Jul 31.
Article in English | MEDLINE | ID: covidwho-690605


INTRODUCTION: We introduced a nurse-led virtual telephone-based stone follow-up clinic (VSC) for the surveillance of patients with asymptomatic renal calculi or those at a high risk of recurrent kidney stone disease (KSD). The aim of this study was to look at the outcomes of VSC and its role in the post COVID era. METHODS: Prospective outcomes were collected for all patients referred to the VSC over a 6-year period (March 2014-April 2020). VSC is led by specialist stone nurses for on-going surveillance of KSD patients. RESULTS: A total of 290 patients were seen (468 individual appointments; 1.6±1.0 per patient), with a mean age of 57.0±15.8 years (range:17-92) and a male:female ratio of 3:2. The referral was for surveillance of asymptomatic small renal stones (230,79.3%); history of recurrent stone disease (45,15.5%); solitary kidneys (5,1.7%); cystine stones, young age and other conditions (10,3.4%). The mean stone size was 5.0±2.7 mm, followed-up with XR KUB (225,77.6%) and USS (65,22.4%), for median duration of 12 months (range: 3-24 months). At the end, 132(45.6%) remained in VSC, 106(36.6%) were discharged, 47(16.2%) returned to face-to-face clinic or treatment, and 5(1.7%) had emergency admissions. Of 47 patients that returned, 23(48.9%) developed new symptoms, 21(44.6%) had stone growth, and 3 defaulted to face-to-face appointment. Thirty-five patients needed surgical intervention (URS-21, SWL-12 and PCNL-1) and 10 were managed conservatively. VSC reduced the cost per clinic appointment from £27.9 to £2/patient (93% reduction), equating to a total saving of £12,006 over the study period. CONCLUSION: Nurse led VSC not only provided a safe follow-up, but also allowed to substantially reduce the cost of treatment by allowing patients to be either discharged or return to a face-to-face clinic or surgical intervention if needed. Post COVID, this model using telemedicine will have a much wider uptake and further help optimise healthcare resources.

Turk J Urol ; 46(3): 169-177, 2020 Apr 14.
Article in English | MEDLINE | ID: covidwho-72934


Coronavirus disease 2019 (COVID-19) is an infectious disease which is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). It has had unprecedented effect on healthcare systems globally with severe impact on every specialist service within the hospital including urology. While it affects the respiratory system causing symptoms ranging from fever, cough, dyspnea, diarrhea, nausea, myalgia and fatigue, it eventually causes pneumonia and respiratory distress needing oxygenation and ventilation. Laboratory diagnosis is required to confirm the diagnosis of COVID-19. Radiological changes are seen on chest XR or CT scan of patients. The surge in patients affected by the disease has led to extreme pressures on healthcare systems by the overwhelming number of critically unwell patients. This scenario has presented challenges to maintain other emergency and essential services. Reallocation of staff, wards and equipment has resulted in cancellations of many surgical procedures, requiring urologists to select only the most essential or critical procedures. The outpatient face-to-face clinics are also cancelled or changed to telephone or video consultations. In some hospitals, urologists are required to work outside of their usual scope of practice helping their respiratory and intensive care unit colleagues. The pandemic is disrupting training and education opportunities for junior medical staff. In this review we provide guidance on the diagnosis and management of COVID-19, the influence it has on urological practice and consider the long-term implications that may be of consequence for years to come.