Consensus of multiple national guidelines: agreed strategies for initial stone management during COVID-19
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Consensus of multiple national guidelines: agreed strategies for initial stone management during COVID‑19 B. Heijkoop1 · E. Galiabovitch1 · N. York2 · D. Webb1 Received: 5 July 2020 / Accepted: 7 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To review the existing available information regarding urolithiasis management and the impact of COVID-19 on this, and propose recommendations for management of emergency urolithiasis presentations in the COVID-19 era. Methods Review of published guidelines produced by Urological Governing Bodies, followed by the literature review regarding urolithiasis management during the COVID-19 pandemic. Results Consistent recommendations across guidelines and literature were that urolithiasis with concurrent sepsis or renal failure remains a urological emergency warranting urgent intervention within the pandemic environment. Ureteric stenting and percutaneous nephrostomy are considered equivalent for decompression in this setting, with both ideally to be performed under local anaesthesia where possible to spare ventilators and reduce aerosol-generating procedures. Greater utilization of medical expulsive therapy and dissolution chemolysis may occur during the pandemic, and longer indwelling stent times may be accepted while definite stone clearance is deferred. Conclusions Urolithiasis will continue to be a source of emergency presentations requiring urgent intervention during the COVID-19 pandemic. However, it is possible to limit these interventions to decompression of the collecting system in the setting of concurrent obstruction or infection, performed under local anaesthesia to limit use of resources and minimise aerosol-generating procedures, with deferral of definitive management. Keywords COVID-19 · Coronavirus · Pandemic · Urolithiasis · Urology
Introduction The COVID-19 global pandemic is potentially the most significant challenge faced by healthcare services in the lifetime of today’s clinicians, and impacts all specialties. Outside of the direct threat to patients and staff from infection with the virus itself, ramifications of bed and equipment shortages (such as Intensive Care Unit (ICU), ventilator and Personal Protective Equipment (PPE) availability) and delays in diagnosis and management of non-COVID conditions will add Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03491-7) contains supplementary material, which is available to authorized users. * B. Heijkoop [email protected] 1
Austin Health, The University of Adelaide, Heidelberg, VIC, Australia
Auckland Regional Urology Service, Auckland, New Zealand
2
additional complexity to management of the situation, and it is likely that alterations to the best practice recommendations will need to be accepted in the short term. Urolithiasis, and in particular renal colic, is a common emergency urological presentation. Timely management is required to control pain and prevent renal
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