Mazzon G. et al., 2024: COVID-19 outbreak impact on urolithiasis treatments: A multicenter retrospective study across 9 urological centers in Italy.

Giorgio Mazzon, Stefania Ferretti, Emanuele Serafin, Francesco Claps, Pietro Acquati, Davide Brusa, Federico Germinale, Giuseppe Celentano, Andrea Pescuma, Andrea Vismara Fugini, Davide Campobasso, Umberto Maestroni, Giovanni Costa, Tonino Morena, Flavia Di Marco, Andrea Baudo, Massimiliano Creta, Nicola Pavan, Marco Ticonosco, Angelo Peroni, Devis Collura, Maria Angela Cerruto, Alessandro Antonelli, Luca Carmignani, Salvatore Micali, Carlo Trombetta, Giovanni Muto, Antonio Celia 
Curr Urol. 2024 Dec;18(4):301-306. doi: 10.1097/CU9.0000000000000246

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.

Comment Peter Alken

Covid – an almost forgotten problem, beeing replaced in the news by other and more focal, but nevertheless more vexing and avoidable problems, because they are exclusively man-made.
“As of August 8, 2022, Italy has reported 21,325,402 total cases and 173,249 deaths, whereas globally, >574 million confirmed cases and >6.3 million deaths have been registered as of July 31, 2022. The exponential surge in COVID-19 cases has overwhelmed health care systems worldwide. Italy, during critical phases, postponed nonurgent operations and revised the management of emergency cases to minimize routine hospitalization, ensuring resources were available for SARSCoV-
2 patient care.”
However, these 9 urological departments did a good job: “Overall, the study found no discernible differences in the quality of surgeries between the 2 periods indicated by similar rates of
SFRs and complications.”

Peter Alken