Efficacy and safety of emergency ureteroscopy as first-line treatment for patients with renal obstruction due to ureteral stones in the COVID-19 pandemic

Abstract

Introduction and objective: Acute renal colic due to ureteral calculi is a common urological emergency that can be managed conservatively, by providing renal drainage and medical management of the pain syndrome followed by planned treatment, or by emergency surgery. With the onset of the COVID-19 pandemic leading to the temporary suspension of elective surgical activity, emergency ureteroscopy has become a valuable modality for the treatment of acute renal obstruction. The objective of this study is to evaluate the efficacy and safety of emergency ureteroscopy as first-line treatment for patients with acute renal obstruction due to ureteral stones during the COVID-19 pandemic. Material and methods: A prospectively collected database of 120 patients with acute renal obstruction due to ureteral stone who underwent emergency ureteroscopy within 24 hours from hospitalization between March 2020 and December 2021, was reviewed. Data on patients’ preoperative characteristics, stone-free rates and complication rates was analyzed. Results: Patients’ mean age was 51.4±15.2 years. Male-to-female ratio was 73.3%/26.7%. Mean preoperative serum creatinine values were 120.1±64.1 umol/l. 33 patients (2.5%) had a solitary functioning kidney. Stone location was proximal ureter in 3 patients (27.5%), mid-ureter – in 12 (10%), distal ureter – in 73 (60.8%), distal and proximal ureter – in 2 cases (1.6%). Mean stone size was 8.1±3.3 mm. Stone-free rate after a single procedure was 95% and mean operative time – 25.1±11.5 min. Postoperative drainage was stent JJ in 34 (28.3%) and ureteral catheter for 12h – in 22 (18.3%) patients. 21 patients (17.5%) had a narrow ureter, necessitating the use of smaller caliber ureteroscope (6 Fr). In 2 patients (1.7%) the ureter could not be accessed and a stent JJ was inserted. Intraoperative complications were present in 5 cases – 1 ureteral perforation (0.8%) and 4 cases of upward stone migration (3.3%). Postoperative complications were fever in 2 patients (1.7%) and postoperative renal colic pain - in 7 (5.8%). Conclusions: The results of this prospective study suggest that emergency ureteroscopy is a safe and effective first-line treatment for acute renal obstruction due to ureteral stones. It offers a one-stage management, without the potential complications of obstruction and loss of renal function due to delayed treatment during the COVID-19 pandemic. Key words: Ureterorenoscopy, Ureteral obstruction, Ureteral stone, Covid-19