COVID-19 outbreak impact on urolithiasis treatments: A multicenter retrospective study across 9 urological centers in Italy

Abstract

Background: The coronavirus disease (COVID-19) pandemic has posed challenges to the global health care community, affecting the management of upper urinary tract stones.

Materials and methods: This retrospective study involved 9 Italian centers. We compared the 12-month period prior to COVID-19 (March 1, 2019, to February 28, 2020; Period A) with the COVID-19 period (March 1, 2020, to February 28, 2021, Period B). This study aimed to compare outcomes during Periods A and B, specifically focusing on the overall number of treatments, rate of urgent/elective cases, and operational complexity.

Results: A total of 4018 procedures were collected, comprising 2176 procedures during Period A and 1842 during Period B, indicating a loss of 15.35% (p < 0.001). In the elective cases, 1622 procedures were conducted in Period A, compared with 1280 in Period B, representing a 21.09% reduction in cases (p = 0.001). All types of stone treatments were affected: extracorporeal shock wave lithotripsy (−29.37%, p = 0.001), percutaneous nephrolithotomy (−26.47%, p = 0.008), retrograde surgeries for renal stones (−10.63%, p = 0.008), and semirigid ureterolithotripsy (−24.86%, p = 0.008). Waiting lists experienced significant delays during Period B. The waiting time (WT) for elective procedures increased during Period B (p < 0.001). For ureteral stones, the mean WT in Period A was 61.44 days compared with 86.56 days in Period B (p = 0.008). The WT for renal stones increased from 64.96 days in Period A to 85.66 days in Period B for retrograde intrarenal surgery (p = 0.008) and from 96.9 days to 1103.9 days (p = 0.035) for percutaneous nephrolithotomy procedures.

Conclusions: Our study demonstrates that COVID-19 significantly disrupted endourological services across the country. Our data underline how patients received treatment over a prolonged period, potentially increasing the risk of stone-related complications and patient discomfort.

Keywords

COVID-19 / Urolithiasis / Percutaneous nephrolithotomy / Retrograde intrarenal surgery / Extracorporeal shock wave lithotripsy

Acknowledgments

None

Statement of ethics

This study was conducted after obtaining ethical approval from each center. Ethical approval from the main investigation site (Bassano) was coded as VI-183, dated February 17, 2021. This study was conducted in accordance with the Declaration of Helsinki (revised in 2013). Informed consent was obtained from all individual participants included in the study.

Conflict of interest statement

No conflict of interest has been declared by the authors.

Funding source

None

Author contributions

GM, SF, MAC, AA, AC: Participated in research design;

GM, SF: Participated in the writing of the paper;

GM, SF, ES, FC, PA, DB, FG, GC, AP, AVF, DC, UM, GC, TM, FDM, AB, MC, NP, MT, AP, DC, LC, SM, CT, GM: Participated in the performance of the research;

GM, SF: Participated in data analysis.

Data availability

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

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