MP18-13 ENDOUROLOGY FOR STONES DURING COVID-19

Abstract

INTRODUCTION AND OBJECTIVE: Guidelines for endourological procedures during COVID-19 have suggested to defer nonobstructed stones, while obstructed/ infected stones should be considered emergencies.1,2 In our centre, screening protocols (as per Ministry of Health's guidelines)3 were implemented with prioritization strategies so that elective care could safely continue, albeit at deescalated rates. COVID or septic patients underwent decompression with stent or nephrostomy insertion, while non-COVID and non-septic patients underwent primary ureteroscopy (URS) or retrograde intrarenal surgery (RIRS). All interventions were done only by consultants, and surgical precautions such as donning of personal protective equipment were undertaken.4 We aim to report the outcomes of endourological surgery for stone disease in our centre during COVID. METHODS: We conducted a prospective review of all endourological surgeries for stones in our centre between 23 Jan and 31 Aug 2020, when all non-necessary surgeries were deferred. RESULTS: 201 surgeries were performed on 159 patients (93 emergencies, 108 electives)- 36 (17.9%) stent insertions, 116 (57.7%) URS and 49 (24.4%) RIRS. 34 patients were females and 125 males. Median age of patients was 50, with 37% ≥ 60. 31 patients were ASA ≥ 3. None were COVID positive. Mean single stone size was 8.17 mm (1-38) and cumulative stone size was 10.63 mm(1-84). 44 patients had multiple stones. The index stone location was proximal ureter in 111 (55.2%), mid ureter 19 (9.45%), distal ureter 67 (33.3%), renal 4 (1.99%). 55 (27.4%) procedures were carried out due to previously stented stones, 10 (4.98%) bilateral obstruction/ single kidney, 77 (38.3%) failed MET/ persistently symptomatic stone, 16 (7.96%) intractable colic, 14 (6.96%) AKI, and 20 (9.95%) sepsis. 166 (66.6%) patients had stent inserted post operatively- 15 with threads that precluded the need for scope guided removal. 27 (10.8%) had a ureteric catheter that was removed prior to discharge. The overall stone free rate was 97.4%;95 (59.7%) were stone free with 1 procedure. 60 (37.7%) required staged procedures. An average of 1.41 procedures/ patient was needed to be stone free. 2 (0.99%) patients had Clavien Dindo Grade III complications. 9 (4.48%) were readmitted- 7 for UTI and 1 for stent symptoms. Median length of stay was 2 days (0- 43). CONCLUSIONS: Our centre demonstrated favourable outcomes in patients undergoing endourological surgery for stone diseases during COVID by following strict screening protocols and surgical precautions. The results support the continuation of endourological surgery with the proposed framework in regions with similar COVID trends.