Lower overall kidney stone treatment rates and increased use of medical expulsive therapy (MET) were among the changes in the kidney stone management that occurred during the peak of the COVID-19 pandemic in 2020, according to studies presented at the AUA2021 Virtual Experience.
John Michael DiBianco, MD, of the University of Michigan in Ann Arbor, and colleagues studied 6375 kidney stone cases managed during 3 time periods: July 1 to December 31, 2019 (pre-COVID [PC]); March 16 to June 15, 2020 (during COVID [DC]); and June 16 to September 15, 2020 (after COVID [AC]). Of these, 4513 were managed with ureteroscopy (URS) and 1862 with shockwave lithotripsy (SWL).
The PC cohort consisted of 3310 cases (2238 URS and 1072 SWL); the DC cohort included 1141 cases (888 URS and 253 SWL); and the AC cohort included 1924 cases (1387 URS and 537 SWL).
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A higher proportion of URS cases were performed DC compared with PC and AC (77.8% vs 67.6% vs 72.1%, respectively), Dr DiBianco and colleagues reported. There was a higher proportion of emergent case in DC compared with PC and AC (21.8% vs 13.7% vs 15.3%, respectively).
Compared with PC and AC patients, DC patients had significantly higher stent placement rates and longer stent dwell times and were more likely to have ureteral stones. DC patients also were more likely to have a positive urinalysis or urine culture and hydronephrosis.
Emergency department (ED) visits and unplanned hospitalization rates did not differ significantly among the 3 study periods.
Dr DiBianco and colleagues obtained study data from the Michigan Urologic Surgery Improvement Collaborative, which maintains a prospective clinical registry of URS and SWL cases.
In an interview, Dr DiBianco explained that some investigators had postulated that the delivery of care to patients with urinary stone disease might change to avert behaviors or situations of high transmission risk. “We were interested in understanding how care might change during the height of the pandemic as a result of patient and environmental factors.”
Not surprisingly, he said, the cases that occurred during the height of the pandemic were more complex and urgent compared with the other study periods. Although this care resulted in increased stent utilization and longer stent dwell times, post-operative ED visits and hospitalizations did not increase, Dr DiBianco said.
In a separate study, Eric M. Ghiraldi, DO, and colleagues at the Yale School of Medicine in New Haven, Connecticut, found that a significantly higher proportion of patients were discharged with MET during March-April 2020 (the peak of the pandemic) compared with March-April 2019 (64.3% vs 49.3%), despite similar baseline characteristics of patients seen in these time periods. The investigators found no difference in the rate of surgical stone management and stent placement at initial presentation. Discharged patients, however, waited significantly longer from initial ED presentation to the time of elective surgery (55.3 vs 33.1 days). Despite the delay, spontaneous stone passage rates were similar between the groups (28.6% vs 29.5%).
“Findings such as these can to be used to educate our patients on the natural history of ureteral stones over a prolonged observation period,” said investigator Stephanie Hanchuk, MD, who reported study findings.
The study included 244 patients: 98 in the March-April 2020 cohort and 146 in the March-April 2019 cohort. Average stone size was 5.1 and 4.9 mm, respectively.
References
DiBianco JM, Daignault-Newton S, Ludlow J, et al. The impact of COVID-19 on surgical care delivery for patients with urinary stones. Presented at: AUA 2020, held September 10-13, 2021. Abstract PD14-08.
Ghiraldi E, Hanchuk S, Buck M, Nair H, Singh D, Motamedinia P. Evaluating spontaneous stone passage rates during the COVID-19 pandemic. Presented at: AUA 2021, held September 10-13, 2021. Abstract MP18-02.
