Ali Kaan Yildiz et al., 2024: How has the COVID-19 pandemic changed treatment preferences of patients with proximal ureteral stones?
Ali Kaan Yildiz, Ahmet Varan, Hakan Kurt, Omer Gokhan Doluoglu, Berat Cem Ozgur
Department of Urology, University of Medical Sciences, Ankara Training and Research Hospital, Ankara, Turkey.
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.
Curr Urol. 2024 Mar;18(1):66-70. doi: 10.1097/CU9.0000000000000143. Epub 2023 Nov 12.
PMID: 38505151 PMCID: PMC10946634 FREE FULL TEXT
Comments 1
Numerous studies have been published on how the COVID-19 pandemic changed treatment preferences. In the current retrospective study, it is described how preferences for ureteral stone treatment were affected.
The first non-COVID-period JUL 2018 -MRS 2020 was compared with the COVID-period MRS 2020-NOV 2021.
URS SWL Conservative
Period 1 41.5% 26.4% 32.2%
Period 2 34.5% 20% 45.5%
It seems as if the patients’ choice was the determining factor. It is easy to understand why the conservative treatment was increased to avoid virus exposure during the hospital visits.
One factor that is not discussed at all was if there were any directions from the urologists with the aim of avoiding anesthesia and associated aerosol spreading of virus. This factor is important, and it is surprising that it was not included in the treatment considerations.
Obviously, the patients’ experience with SWL was bad, because by choosing SWL the patients expected repeated treatments and several hospital visits.
With this background, the shift in treatments were surprisingly small.
The reviewer had expected that active stone-removal would have decreased in case of need of anesthesia, but the reason apparently was another.
The reviewer disagrees with the authors’ conclusion that further studies on the influence of the pandemic in larger populations and with longer follow-up is necessary. No need for that when the pandemic is over. In case of a new pandemic wave, its is desirable that the urological clinic/hospital has clear guidelines in the treatment of proximal ureteral stones, in the size range 6-9 mm, so that the patients can be adequately advised regarding the treatment and that precautions are taken so that the hospital staff not is unnecessarily exposed to virus.
Hans-Göran Tiselius