How has the COVID-19 pandemic changed treatment preferences of patients with proximal ureteral stones?

Abstract

Background: The impact of the coronavirus disease 2019 (COVID-19) pandemic on patient decision making remains uncertain. This study aimed to investigate the effect of the pandemic on treatment preferences of patients with proximal ureteral stones.

Materials and methods: Retrospective data regarding treatment preferences of patients diagnosed with symptomatic proximal ureteral stones between July 2018 and November 2021 at a single center were analyzed. Data from 493 patients were analyzed according to 2 groups, including patients diagnosed during the COVID-19 pandemic and those diagnosed during an equivalent period of time before the pandemic.

Results: Preference for conservative treatment increased during the COVID-19 pandemic (p = 0.009). In patients who had previously undergone shock wave lithotripsy (SWL), the preference for SWL decreased and the preference for conservative treatment increased during the COVID-19 pandemic (p = 0.042). Multiple logistic regression analysis revealed a significant correlation between a preference for conservative treatment during the pandemic and no prior spontaneous stone passage (p = 0.003; odds ratio [OR], 2.48; 95% confidence interval [CI], 1.45-4.23), no hydronephrosis (p = 0.035; OR, 3.57; 95% CI, 1.34-9.49), and a visual analog scale score of 4 or less (p = 0.018; OR, 1.97; 95% CI, 1.15-3.38).

Conclusions: A significant increase in the preference for conservative treatment was observed among patients diagnosed during the pandemic, and patients with a history of SWL demonstrated a preference shift from SWL to conservative treatment.

Keywords

COVID-19 pandemic / Treatment preference / Ureter / Urolithiasis

Acknowledgments

None.

Statement of ethics

Approval for this study was granted by the local ethics committee, and all procedures were conducted in accordance with the principles of the Helsinki Declaration. Informed consent was obtained from all individual participants included in the study. This study was retrospectively registered, with a trial registration number NCT04924790,10/June/2021.

Conflict of interest statement

No conflict of interest has been declared by the author.

Funding source

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

All authors contributed to study conception and design.

AKY: Conception, data interpretation, manuscript writing and editing;

AV and HK: Data analysis;

OGD: Data analysis and interpretation, manuscript editing;

BCO: Conception, data interpretation, supervision and administrative support.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

[1] Moghadas SM, Shoukat A, Fitzpatrick MC, et al. Projecting hospital utilization during the COVID-19 outbreaks in the United States. Proc Natl Acad Sci U S A 2020; 117(16):9122-9126.

[2] Puliatti S, Eissa A, Eissa R, et al. COVID-19 and urology: A comprehensive review of the literature. BJU Int 2020; 125(6):E7-E14.

[3] Jiang T, Osadchiy V, Weinberger JM, et al. Impact of the COVID-19 pandemic on patient preferences and decision making for symptomatic urolithiasis. J Endourol 2021; 35(8):1250-1256.

[4] Türk C, Petřík A, Sarica K, et al. EAU guidelines on interventional treatment for urolithiasis. Eur Urol 2016; 69(3):475-482

[5] Kadyan B, Sabale V, Mane D, et al. Large proximal ureteral stones: Ideal treatment modality? Urol Ann 2016; 8(2):189-192.

[6] Seitz C, Tanovic E, Kikic Z, Fajkovic H. Impact of stone size, location, composition, impaction, and hydronephrosis on the efficacy of holmium:YAG-laser ureterolithotripsy. Eur Urol 2007; 52(6):1751-1759.

[7] Preminger GM, Tiselius HG, Assimos DG, et al. 2007 Guideline for the management of ureteral calculi. Eur Urol 2007; 52(6):1610-1631.

[8] Türk C, Knoll T, Seitz C, et al. Medical expulsive therapy for uretero-lithiasis: The EAU recommendations in 2016. Eur Urol 2017; 71(4):504-507.

[9] Sarkissian C, Noble M, Li J, Monga M. Patient decision making for asymptomatic renal calculi: Balancing benefit and risk. Urology 2013; 81(2):236-240.

[10] Fann CY, Huang PC, Yen AM, Chen HH. Patient utility measurement for managing ureteral stones: A modified standard gamble approach. Value Health Reg Issues 2012; 1(1):87-92.

[11] Mays NB, Petruckevitch A, Snowdon C. Patients' quality of life following extracorporeal shock-wave lithotripsy and percutaneous nephrolithotomy for renal calculi. Int J Technol Assess Health Care 1990; 6(4):633-642.

[12] Drake T, Grivas N, Dabestani S, et al. What are the benefits and harms of ureteroscopy compared with shock-wave lithotripsy in the treatment of upper ureteral stones? Eur Urol 2017; 72(5):772-786.