Impact of COVID-19 Pandemic on Management of Urolithiasis

Table of Content

Introduction 

COVID-19 pandemic has had a major impact on health care services globally leading to reduced hospital admissions due to fear of patients contracting the disease and postponing scheduled treatments to conserve beds and staff to manage critically ill COVID-19 patients. Similar impacts were observed in patients with urinary calculi. Procedures related to urolithiasis have been postponed. Patients avoided seeking treatment thereby increasing the severity of the symptoms and risk complications.

Aim

The impact of the early COVID-19 pandemic on the presentation and management of urinary calculi around the globe was assessed in this systematic review.

Method

Study Design

  • Systematic review.

Treatment Strategy

  • The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach.
  • A systematic search of Medline, Embase, and Central databases was conducted to identify the studies that compared the presentation and management of urinary calculi before and during the pandemic.
  • The studies covering the important clinical aspects of the stone disease were included.  

Endpoints

  • Change in the number of patients presenting with urolithiasis
  • Stone size
  • Stone location
  • Time from onset of symptoms to presentation
  • Complications
  • Type of management

Results

  • Out of the 231 studies which were identified, 18 studies were eligible for inclusion.
  • There was a significant decline in the number of patients presenting to hospital ranging from 21%-70% at the beginning of the pandemic.
  • A trend of higher proportion of distal ureteral stones was reported in 4 studies.
  • The associated complication rates were higher during the pandemic.
  • There were mixed reports in terms of delay to presentation and use of conservative management.
  • An increasing trend in nephrostomies was noted at the onset of the pandemic.
  • A consistent trend toward reduction in elective procedures with wide variations was observed (shockwave lithotripsy 38%-98%, percutaneous nephrolithotomy 94%-100%, and ureteroscopy 8%-98%).

Conclusion

  • The impact of COVID-19 on urolithiasis has been highlighted in this systematic review.
  • The onset of COVID-19 pandemic resulted in differences in the number of patients presenting to hospital, rates of complications, and management of urinary calculi, including surgical interventions.
  • The findings are useful in elucidating the impact of early pandemic, variations in practices, and would be beneficial for future comparisons.

J Endourol. 2022 May 23. Doi: 10.1089/end.2022.0167.