TikTok Influence on Rates of Tonsillectomies for Tonsil Stones.

INTRODUCTION: Tonsillectomy is one of the most common otolaryngologic surgeries and is increasingly being performed for the management of tonsil stones or tonsilloliths. Incidentally, over the years, tonsilloliths have become a popular topic on the social media platform TikTok (ByteDance, Beijing, China) and we propose that this may be influencing the trends of tonsillectomies for tonsil stones.  Objectives: We aim to assess rates of outpatient visits and tonsillectomies for tonsil stones at our institution as well as analyze videos on TikTok regarding tonsil stones. METHODS: A retrospective chart query was performed. Data including the number of patient encounters per month with a diagnosis code of tonsilloliths were collected from July 2016 to December 2021. The number of TikTok videos under the search result "tonsil stones" and the content of these videos were reviewed. RESULTS: There were 126 patients seeking evaluation for tonsil stones with an average age of 33.4 years, and 76% were females. The number of patients who underwent a tonsillectomy for tonsil stones increased from two in the first full year of collection in 2017 to 13 in 2021. Similarly, the average number of patients presenting for tonsil stone evaluation per month increased steadily from 1.0 in 2017 to 3.3 in 2021. TikTok video content under the search result "tonsil stones" varied and the number of videos on this topic has increased in recent years. CONCLUSION: Rates of patients seeking tonsillectomy for tonsil stones increased from 2016 to 2021 in conjunction with the rising popularity of TikTok. Given the numerous TikTok videos featuring tonsil stones, we believe that this social media platform may be influencing the number of patients seeking evaluation for tonsil stones. This data may be used to understand future influence patterns of social media posts on healthcare consumer behavior and patient care practices.

Dietary supplements' knowledge, attitude and consumption pattern among United Arab Emirates population

PurposeTo study the consumption pattern, attitude and knowledge of the general population about dietary supplements (DS) in the United Arab Emirates (UAE).Design/methodology/approachA community-based cross-sectional study was conducted to collect data on knowledge, attitude and consumption pattern related to the use of DS. Participants aged = 18 years were asked to complete a self-administered online questionnaire that included demographic characteristics, health and lifestyle information, consumption patterns, attitudes and knowledge levels regarding the use of DS.FindingsA total of 207 individuals participated in the study, and 117 (56.5%) participants reported using DS products as influenced by the pandemic of coronavirus disease 2019 (COVID-19), of which 63 (53.8%) participants had been using DS for more than one month but less than one year. The majority of the participants was females (64.7%), non-UAE nationals (60.9%) and employed (51.7%). Multivitamins (77.8%) were the most commonly used DS. Use of DS was more prevalent among older participants (n = 78 (61.9%), p = 0.006), non-UAE nationals (n = 79 (62.7%), p = 0.025) and employed (n = 69 (64.5%), p = 0.023). Improving general health (76.1%) and immune booster (47%) were the most frequently identified reasons for using DS, which is relatable to the COVID-19 pandemic. The majority of study participants (72.12%) reported knowing relatively little about the use of DS. About 154 participants (74.4%) did not know that DS products do not treat diseases.Research limitations/implicationsFurther studies with a larger sample size need to be conducted to examine the association between gender or chronic disease and the consumption and type of DS products used to fill the gap in the literature and overcome the limitations identified in this study.Originality/valueThis study highlights the need for community education programs and strategies that can raise awareness of the health benefits and risks of using DS. Further studies with a larger sample size need to be conducted to examine the association between gender or chronic disease and the consumption and type of DS products used to fill the gap in the literature and overcome the limitations identified in this study.

Worldwide Interest in Vitamin D, Negative Effects on Kidneys, and Bone Density: Analysis of Google Trends Data

Background: Besides its role in calcium homeostasis and bone mineralization, vitamin D may also reduce the risk of cancer, cardiovascular and autoimmune diseases. Excessive vitamin D intake can lead to life-threatening hypercalcemia and toxicity, however. Here, we wanted to determine the relative search volume (RSV) of interest in vitamin D and its adverse biological effects (hypercalcemia, renal failure, kidney stones, bone density).Methods: We used data from Google Trends to assess changes in RSV trends across the world's regions. Data were extracted via the search terms "cholecalciferol", "ergocalciferol, "hypercalcemia", "acute renal failure", "kidney stones", and "bone density" from queries in English from 1 January 2004 to 1 October 2018 in the tool's related query database. Statistical analysis was performed using SPSS (R) 22.0 for Windows (IBM Inc., Armonk, NY, USA, 10504-1722).Results: There was a correlation between the RSV of cholecalciferol and ergocalciferol (Spearman's correlation) and the RSV of hypercalcemia, renal failure, kidney stones, and bone density. As measured by the change in RSV score, the trend for interest in kidney stones increased more rapidly than that for the other search terms. There was a positive correlation between the RSV score for cholecalciferol (or ergocalciferol) and renal failure and between the RSV score for cholecalciferol (or ergocalciferol) and kidney stones, whereas there was a negative correlation between cholecalciferol and hypercalcemia. The interest of ergocalciferol increased in parallel with the interest in bone density. The highest concentration of interest in cholecalciferol occurred in North America, Europe, India and Australia, whereas interest in ergocalciferol was greater in Central and South America, Spain, and Thailand. Interest in kidney stones was greater than cholecalciferol in North America, Brazil, India, and Australia, while interest in bone density was greater than cholecalciferol in North America, Brazil, Italy, Spain, South Africa, and Australia.Conclusions: In the pre-pandemic COVID-19 (COronaVIrus Disease 19) era, our preliminary results showed a positive correla-tion between global interest in cholecalciferol and kidney stones and renal failure, respectively. However, we found an unexpected negative correlation between global interest in cholecalciferol and hypercalcemia. Additionally, we found a positive correlation between global interest in ergocalciferol and bone density. These correlations can inform health interventions and education.

Leveraging access to technology and enhanced surgical technique (LATEST) in laparoscopic bile duct exploration (LBDE).

Single-stage management of choledocholithiasis with concomitant gallstones consists of performing either laparoscopic bile duct exploration (LBDE) or intra-operative endoscopic retrograde cholangiopancreatography at the same time as laparoscopic cholecystectomy. Transductal LBDE is associated with significantly higher post-operative morbidity, longer operative times and longer hospital stay when compared to transcystic LBDE. The aim of this study was to report the transcystic exploration rate and post-operative outcomes from LBDE before and after implementation of the LATEST (Leveraging Access to Technology and Enhanced Surgical Technique) principles. METHODS: A retrospective review of 481 consecutive patients between February 1998 and July 2021 was performed. Patients were assigned into two groups determined by whether they were operated before or after the implementation of LATEST. Data collected included pre-operative demographic information, medical co-morbidity, pre-operative investigations, and intra-operative findings (including transcystic exploration rate, negative choledochoscopy rate, use of holmium laser lithotripsy and operative time). Outcomes of this study were the transcystic exploration rate, stone clearance rate, conversion to open surgery, post-operative morbidity and mortality, and length of post-operative hospital stay. RESULTS: The pre-LATEST group contained 237 patients and the LATEST group comprised of 244 patients. Ultra-thin choledochoscopes and holmium laser lithotripsy were used more frequently in the LATEST group (41.4% and 18.4%, respectively). Enhanced surgical techniques (correction of the cystic duct-CBD junction and the trans-infundibular approach) were also performed more frequently in the LATEST group. More patients in the LATEST group received transcystic LBDE (86.1% vs 11.0%, p < 0.0001). The LATEST group had significantly higher stone clearance rates (98.8% vs 93.7%, p = 0.0034), reduced post-operative morbidity and shorter post-operative hospital stay (4 days vs 1 day, p < 0.0001). CONCLUSIONS: LATEST describes four key factors that can be used when performing LBDE. The adoption of LATEST in LBDE is associated with an increased stone clearance, a higher transcystic exploration rate and reduced post-operative morbidity.

Rothko, the Rolling Stones, and Matisse: Grounding in a time of uncertainty

In surfing the waves of COVID-19 and the current socio-political culture of alarm, uncertainty, and anxiety, I describe how exploring works by Mark Rothko, the Rolling Stones, and Henri Matisse helped me find grounded experiential footing during the pandemic. Rothko's multiform and later paintings encouraged exploration of the soul, experiences of the ineffable, of life-and-death. In contrast, the Rolling Stones inspired me to feel my heart, my beat, my connectedness to rhythm and knowledge that presence rests on interpersonal connection. Finally, as seen in The Red Studio, Matisse and his use of color re-vivify the experience of living, and provided a roadmap back to optimism.

Exploring the Capabilities of a Lightweight CNN Model in Accurately Identifying Renal Abnormalities: Cysts, Stones, and Tumors, Using LIME and SHAP

Kidney abnormality is one of the major concerns in modern society, and it affects millions of people around the world. To diagnose different abnormalities in human kidneys, a narrow-beam x-ray imaging procedure, computed tomography, is used, which creates cross-sectional slices of the kidneys. Several deep-learning models have been successfully applied to computer tomography images for classification and segmentation purposes. However, it has been difficult for clinicians to interpret the model's specific decisions and, thus, creating a "black box” system. Additionally, it has been difficult to integrate complex deep-learning models for internet-of-medical-things devices due to demanding training parameters and memory-resource cost. To overcome these issues, this study proposed (1) a lightweight customized convolutional neural network to detect kidney cysts, stones, and tumors and (2) understandable AI Shapely values based on the Shapley additive explanation and predictive results based on the local interpretable model-agnostic explanations to illustrate the deep-learning model. The proposed CNN model performed better than other state-of-the-art methods and obtained an accuracy of 99.52 ± 0.84% for K = 10-fold of stratified sampling. With improved results and better interpretive power, the proposed work provides clinicians with conclusive and understandable results.

Outcomes of AstraZeneca vaccine for relapse and COVID-19 infection in people with multiple sclerosis

Background: People with chronic diseases of the immune system, such as multiple sclerosis (MS), are at risk for Covid-19 disease. However, more research is needed with long-term follow-up. The aim of the study was to follow up people with MS (PwMS) for up to three months after AstraZeneca vaccination for the recurrence of MS and Covid-19 infection. Methods: This study was a case study (descriptive-analytical) of follow-up type. The study population was PwMS over 18 years of age in Kermanshah province who received both doses of the AstraZeneca vaccine. This study was conducted from August to November 2021. Sampling was done with existing methods based on the National MS Registry of Iran (NMSRI). Demographic information of patients was extracted from NMSRI. A researcher-made form was used to collect information by telephone three months after vaccination about clinical characteristics, Covid-19 infection, and recurrence of MS. Data were analyzed using SPSS-25 software. Results: Study participants were 40 MS patients with a mean (SD) age of 39.27 (8.8) years, including 32 (80.0%) women. A mean of 9.39 (4.6) years had passed since The patients were diagnosed with MS, and 29 (76.4%) had RR type MS. Four patients (10%) relapsed between the second dose and three months later, of whom two (50%) had sensory symptoms, one (25%) had optic nerve involvement, and one (25%) had motor symptoms and pyramidal pathway involvement. The symptoms of Covid-19 were mild in three patients (10%), while severe symptoms developed in one patient (10%) who received rituximab. Among the patients, no cases of thrombosis were observed. Infusion therapy, a leg fracture, and kidney stones were the only hospitalized cases. Conclusion: Covid-19 and MS relapse prevalence did not differ significantly in the three months before and after vaccination. There is a need for further studies with a longer follow-up period.

The effect of COVID-19 outbreak on urological procedures for urinary stones: data from three high-volumes centers in China.

China has been the first country to be affected by the COVID-19 outbreak. The pandemic resulted in significant disruption of Health Care Services worldwide, and this effect on treatments for urinary stones is currently unclear. This is the first retrospective study involving three tertiary referral centers for urolithiasis across China. We evaluated surgical volumes and peri-operative outcomes of procedures delivered for upper urinary tract stones. We compared trimester prior to restrictions for COVID-19 (October 1st, 2019 to December 31st, 2019, period A), during restrictions (February 1st, 2020 to March 31st, 2020, period B), and afterword (April 1st, 2020 to June 31st, 2020, period C). A total of 2,543 procedures have been carried out. We observed a loss of 743 cases during period B (-29.2%) and 201 during period C (-7.9%). Percutaneous surgery showed the worst reduction, with 507 mini-PCNLs delivered in period A, 168 in period B (-60.8%), and 389 (-18.3%) in period C (p = 0.001). A worst trend was shown for standard PCNLs with 84 procedures carried out in period A, 5 in period B (-95.2%), and 9 (-89.2%) in period C (p = 0.001). Retrograde surgery also decreased, from 420 cases in period A to 190 cases in period B (-54.8%). An increment was however seen in period C when 468 cases have been carried out (+ 11.4%, p = 0.008). In term of SFRs, a difference was noticed for RIRSs, being 69.2%, 80.5%, and 69.3% during three periods (p = 0.045) and semirigid ureteroscopies (90.3%, 97.1%, and 84.8%, p = 0.013). Charlson's Comorbidity Score could not show any difference between groups as well as no differences in term of post-operative complications have been noticed.

Comparison of shock wave lithotripsy and ureteroscopy in patients with proximal ureteral stones under the COVID-19 pandemic.

PURPOSE: To compare the effectiveness, safety, and cost between ultrasound-guided shock wave lithotripsy (SWL) with an early second session protocol and ureteroscopy (URS) in patients with proximal ureteral stones using the propensity score matching (PSM) method based on a large prospective study. METHODS: This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent lithotripsy (SWL or URS) for proximal ureteral stones were enrolled. The stone-free rate (SFR), complications, and cost were recorded. PSM analysis was performed. RESULTS: A total of 1230 patients were included, of whom 81.1% (998) were treated with SWL and 18.9% (232) were treated with URS. After PSM, the SWL group had an equivalent SFR at one month (88.7 vs. 83.6%, P = 0.114) compared with the URS group. Complications were rare and comparable between the two groups, while the incidence of ureteral injuries was higher in the URS group compared with the SWL group (1.4 vs. 0%, P = 0.011). The hospital stay was significantly shorter (1 day vs. 2 days, P < 0.001), and the cost was considerably less (2000 vs. 25,053, P < 0.001) in the SWL group compared with the URS group. CONCLUSION: This prospective PSM cohort demonstrated that ultrasound-guided SWL with an early second session protocol had equivalent effectiveness but better safety and lower cost compared with URS in the treatment of patients with proximal ureteral stones, whether the stones were radiopaque or radiolucent. These results will facilitate treatment decisions for proximal ureteral stones.

Laparoscopic Common Bile Duct Exploration Using a Disposable Bronchoscope.

Laparoscopic common bile duct exploration (LCBDE) remains underutilized in the management of common bile duct (CBD) stones. The exact cause of this under-utilization remains unclear; however, identified barriers to LCBDE implementation include lack of training and unavailability of dedicated instruments. LCBDE is an attractive alternative for stone retrieval in patients with Roux-en-Y gastric bypass given the anatomical difficulty in endoscopic retrograde cholangiopaneatography (ERCP). Direct visualization through choledochoscopy is the method of choice for LCBDE. However, dedicated choledoscopes are expensive and not widely available, which may lead surgeons to seek for alternatives at their particular environment. With the COVID-19 pandemic, disposable bronchoscopes have become widely accessible at our institution, raising the possibility of using one for direct vision of the biliary tract. We present the case of a 61-year-old male with past medical history of Roux-en-Y gastric bypass, who presented to the emergency department with a CBD stone. Successful LCBDE was achieved with the aid of a disposable bronchoscope for direct visualization of the biliary tract. Supplementary Information: The online version contains supplementary material available at 10.1007/s12262-022-03642-7.

Primary Definitive Treatment versus Ureteric Stenting in the Management of Acute Ureteric Colic: A Cost-Effectiveness Analysis.

Objectives: To analyze the differences in cost-effectiveness between primary ureteroscopy and ureteric stenting in patients with ureteric calculi in the emergency setting. Patients and Methods: Patients requiring emergency intervention for a ureteric calculus at a tertiary centre were analysed between January and December 2019. The total secondary care cost included the cost of the procedure, inpatient hospital bed days, emergency department (A&E) reattendances, ancillary procedures and any secondary definitive procedure. Results: A total of 244 patients were included. Patients underwent ureteric stenting (62.3%) or primary treatment (37.7%), including primary ureteroscopy (URS) (34%) and shock wave lithotripsy (SWL) (3.6%). The total secondary care cost was more significant in the ureteric stenting group (GBP 4485.42 vs. GBP 3536.83; p = 0.65), though not statistically significant. While mean procedural costs for primary treatment were significantly higher (GBP 2605.27 vs. GBP 1729.00; p < 0.001), costs in addition to the procedure itself were significantly lower (GBP 931.57 vs. GBP 2742.35; p < 0.001) for primary treatment compared to ureteric stenting. Those undergoing ureteric stenting had a significantly higher A&E reattendance rate compared with primary treatment (25.7% vs. 10.9%, p = 0.02) and a significantly greater cost per patient related to revisits to A&E (GBP 61.05 vs. GBP 20.87; p < 0.001). Conclusion: Primary definitive treatment for patients with acute ureteric colic, although associated with higher procedural costs than ureteric stenting, infers a significant reduction in additional expenses, notably related to fewer A&E attendances. This is particularly relevant in the COVID-19 era, where it is crucial to avoid unnecessary attendances to A&E and reduce the backlog of delayed definitive procedures. Primary treatment should be considered concordance with clinical judgement and factors such as patient preference, equipment availability and operator experience.

Shock Wave Lithotripsy Outcomes for Upper and Lower Ureteral Stones in Non-obese and Non-Pre-stented Adults: Is One Session Sufficient?

Purpose This study aims to evaluate differences in shock wave lithotripsy (SWL) outcomes between upper and lower ureteral stones and identify patients who are likely to have a stone-free status after one session of SWL. Materials and methods After approval from the institutional review board and from a prospectively maintained database of 628 patients, 182 were retrospectively identified, who have had SWL for a single lower or upper ureteral stone and met the inclusion criteria. Age, body mass index (BMI), and stone size were similar among the groups. This study included non-pre-stented patients with solitary lower or upper ureteral radiopaque stones identified on non-contrast-enhanced computed tomography (NCCT), did not have acute obstruction, and had either normal body mass index (BMI) or overweight status. Patients were treated with Sonolith i-sys electroconductive lithotripter (focal length: 21 cm) (EDAP TMS, Vaulx-en-Velin, France). Success was defined as the absence of residual of any size or a residual of ≤2 mm on NCCT after one month, whereas failure was having fragments >2 mm or requiring surgical intervention. Post-SWL assessments were completed one week after every session with an X-ray of the kidney-ureter-bladder (KUB-XR) and NCCT after one month. Results The upper and lower ureteral stone-free rates (SFRs) were 95% and 64.7%, respectively. Of them, 65% and 45%, respectively, were stone-free after one session. The cohort having a stone-free status after one SWL session was similar in age, sex, BMI, and stone density. The upper ureteral stone arm has a significant chance for one SFR session with a larger stone size, shocks per session, and maximum power delivered. In the receiver operating characteristic (ROC) curves, the optimal cut point number of sessions of 1.5, mean stone density (MSD) of 895, and stone size of 10.5 mm are the most likely to have successful SWL in the ureter. Conclusion For patients having ureteral stones with favorable factors, SWL modality is effective and safe. Moreover, SWL can be done for one or two sessions only with the presence of favorable factors.

The Future of Preventative Medicine: Health Promotion Programs as a Tool to Reduce Administrative Costs and Improve Health Outcomes

[...]healthcare systems are extremely strained due to higher rates of preventable conditions across Canada and the United States. According to Burden and Burch, there are five definitive processes involved in inquiry-based learning: 1) Identifying and Formulating Problems, 2) Formulating Hypotheses, 3) Collecting Quantifiable and/or Qualitative Data, 4) Analyzing the Data to form Interpretations related to Hypotheses and 5) Drawing Conclusions. The following factors were compounding influences on the student's receptivity: 1) parental influence on smoking habits outweighing any impacts on the campaign and/or, 2) socio-economic status. [...]this means health promotion programs require action to be taken from community members in the communities themselves to lead change initiatives. [...]Aldana found in 28 studies reporting cost savings, with 7 studies showing expended calculations for cost-benefit ratios and financial returns averaging $3.48 for every dollar.

Kidney stones . . . and other stories

[...]it’s hard to draw useful conclusions about the value of parathyroidectomy from these data because people treated surgically had higher rates of stone formation before treatment and higher serum calcium concentrations (J Clin Endocrinol Metab doi:10.1210/clinem/dgac193). Art improves life Virtual visits to an art gallery improve the quality of life for older people, according to a trial from Canada. Among 100 participants, all over 65, those randomised to weekly online guided tours of the Montreal Museum of Fine Arts showed improved scores for social isolation, wellbeing, quality of life, and frailty when compared with controls who didn’t participate in cultural activities (Front Med doi:10.3389/fmed.2022.969122/full).

Urological stone disease: a 5-year update of stone management using Hospital Episode Statistics.

OBJECTIVE: To reassess the trends in upper urinary tract (UUT) stone disease burden and management in the UK during the last 5 years. METHODS: The present paper is our third quinquennial analysis of trends in the management of renal stones in England. Data were collected using the Hospital Episode Statistics database for the years 2015-2020 inclusive. These were then analysed, summarized and presented. RESULTS: The number of UUT stone episodes increased by 2.2% from 86 742 in 2014-2015 to 88 632 in 2019-2020 but annual prevalence remained static at 0.14%. The number of UUT stone episodes in those of working age has remained static but increased by 9% for patients aged > 60 years (from 27 329 to 29 842). The number of shockwave lithotripsy (SWL) treatments decreased by 6.8%. There was a further increase in the use of ureteroscopy (URS) between 2015 and 2020 of 18.9%. Within this subgroup, flexible URS had the most rapid increase in use, with a rise of 20.4% from 7108 to 8558 recorded cases. Over the 20-year period from 2000 to 2020 there was a remarkable 257% increase in URS cases. There was a further decline in open surgery for UUT stone disease by 40%. Stone surgery day-case numbers have increased by 14.7% (from 31 014 to 35 566), with a corresponding decline in the number of bed days of 14.3%. Emergency cases increased by 40%, while elective cases saw a slight increase of 1.9%. CONCLUSION: The present study shows a plateauing in the prevalence of UUT stone disease in England in the last 5 years, with a move towards day-case procedures and an increase in the proportion of emergency work. For the first time in England, URS has overtaken SWL as the most common procedure for treating UUT stone disease, which might reflect patients' or physicians' preference for a more effective definitive treatment.

Yellow Urticaria in a patient with gallbladder stones: A case report and review of literature

Yellow urticaria is a rare type of urticaria and the exact etiology behind it is still unclear. We report a case of 53-years-old medically free male with pruritic yellow to orange wheals over his trunk and extremities after receiving his first dose of COVID-19 Vaccine (Pfizer-BioNTech) with no evidence of angioedema or anaphylaxis. All the reported cases of yellow urticaria almost share the same cause which is hyperbilirubinemia due to wide spectrum of liver diseases. In conclusion, it is crucial for clinicians to be familiar with this presentation of yellow urticaria and correlate it with the patient history related to liver disease , as this urticaria often signify the presence of various liver disorders.

What is the best way to manage ureteric calculi in the time of COVID-19? A comparison of extracorporeal shockwave lithotripsy (SWL) and ureteroscopy (URS) in an Australian health-care setting.

Objectives: To determine the best way to intervene for ureteric stones which still require treatment during the COVID-19 pandemic, with respect to infection control. In this setting, in which resources are constrained, extracorporeal shockwave lithotripsy (SWL) has prima facie advantages over ureteroscopy (URS). It is also necessary to also consider posttreatment resource consumption in regards to complications and repeat procedures. Subjects and methods: The ideal ureteric stone treatment during a pandemic such as COVID-19 would involve minimum resource consumption and a minimum number of patient attendances. We compared all patients initially treated with SWL to those initially treated with URS for acute ureteral colic within the state of Victoria, Australia in 2017. Results: A total of 2724 ureteric stones were analyzed, a cumulative "3-month exposure and burden on the healthcare system" was calculated for each patient by their initial procedure type. The readmission rate for URS was significantly higher than for SWL, 0.92 readmissions/patient for URS versus 0.54 readmissions/patient for SWL (P < .001). The cumulative hospital stay per patient for these two procedures was 2.35 days for SWL versus 3.21 days for URS (P < .001). The number of procedures per patient was 1.52 for SWL versus 1.89 for URS (P = .0213). Conclusions: Patients with ureteric stones treated initially by SWL have shorter length of stay with fewer overall attendances and procedures at 3 months than those treated with URS. During a pandemic such as COVID-19, SWL may have benefits in preserving hospital resources and limiting opportunity for virus transmission, compared to URS.

Ambulatory Percutaneous Nephrolithotomy May Be Cost-Effective Compared to Standard Percutaneous Nephrolithotomy.

Background: Coronavirus disease 2019 (COVID-19) changed the practice of medicine in America. During the March 2020 lockdown, elective cases were canceled to conserve hospital beds/resources resulting in financial losses for health systems and delayed surgical care. Ambulatory percutaneous nephrolithotomy (aPCNL) has been shown to be safe and could be a strategy to ensure patients receive care that has been delayed, conserve hospital resources, and maximize cost-effectiveness. We aimed to compare the safety and cost-effectiveness of patients undergoing aPCNL against standard PCNL (sPCNL). Materials and Methods: Ninty-eight patients underwent PCNL at Indiana University Methodist Hospital, a tertiary referral center, by three expert surgeons from January 2020 to September 2020. The primary outcome of the study was to compare the 30-day rates of emergency department (ED) visits, readmissions, and complications between sPCNL and aPCNL. Secondary outcomes included cost analysis and stone-free rates (SFRs). Propensity score matching was performed to ensure the groups were balanced. Statistical analyses were performed using SAS 9.4 using independent t-tests for continuous variables and chi-square analyses for categorical variables. Results: Ninety-eight patients underwent PCNL during the study period (sPCNL = 75 and aPCNL = 23). After propensity score matching, 42 patients were available for comparison (sPCNL = 19 and aPCNL = 23). We found no difference in 30-day ED visits, readmissions, or complications between the two groups. aPCNL resulted in cost savings of $5327 ± 442 per case. SFRs were higher for aPCNL compared with sPCNL. Conclusions: aPCNL appears safe to perform and does not have a higher rate of ED visits or readmissions compared with sPCNL. aPCNL may also be cost-effective compared with sPCNL.