MP26-20: Impact of COVID-19 on the management of ureteric stones in the UK: the COVID Stones study

Matthew Byrne*, Oxford, United Kingdom, Fanourios Georgiades, Cambridge, United Kingdom, Catherine Lovegrove, Oxford, United Kingdom, Tobias Klatte, Berlin, Germany, Kasra Saeb-Parsy, Cambridge, United Kingdom, Rajeev Kumar, Oxford, United Kingdom, Alexander Light, Cambridge, United Kingdom, Josephine Rahman, Bristol, United Kingdom, Catherine Dominic, London, United Kingdom, Senthooran Kathiravelupillai, Cambridge, United Kingdom, Sarah Howles, Oxford, United Kingdom, Grant Stewart, Cambridge, United Kingdom, Ben Turney, Oxford, United Kingdom, Oliver Wiseman, Cambridge, United Kingdom, . COVID Stones Collaborative, Oxford, United Kingdom

Introduction: In the COVIDStones study, we aimed to determine how management of ureteric stones changed during the COVID-19 pandemic in the United Kingdom. The primary outcome was success of primary treatment modality as determined by no additional treatment required for the index ureteric stone.

Methods: The COVID Stones study was a multi-centre retrospective study of consecutive adults diagnosed with CT-proven ureteric stone disease at 19 UK sites. We compared a pre-pandemic period (23/3/19 to 22/6/19) to a period during the pandemic (the 3 month period after the first SARS-CoV-2 case at individual sites). Our protocol was published in advance (Available at: https://doi.org/10.22374/jeleu.v3i3.96).

Results: A total of 3755 patients were included (pre-pandemic = 1963 patients; pandemic = 1792 patients). Age, gender, and stone size were similar between groups (p>0.05).

Patients during the pandemic had significantly lower hospital admission rates (pre-pandemic = 54.2% vs pandemic = 46.6%, p<0.001), shorter length of stay (mean = 4.0 vs. 3.2 days, p=0.01), and higher rates of use of alpha-blockers (16.1% vs. 23.3%, p<0.001). In the cohort of patients who received interventional management (pre-pandemic, n=790 [44.1%] vs. pandemic, n=686 [34.9%]), rates of ESWL (22.8% vs. 33.9%, p<0.001) were significantly higher; rates of ureteroscopy (56.7% vs. 47.7%, p<0.01) and stent insertion (67.9% vs. 54.5%, p>0.001) were lower; and there was no difference in rates of nephrostomy (10.5% vs. 7.1%, p=0.76) during the pandemic. Fewer patients had a general anaesthetic during the pandemic (pandemic=78.0% vs. pre-pandemic=52.9%, p=0.0001).

During the pandemic, there was no difference in success of primary treatment overall, including both non-interventional and interventional modalities (pre-pandemic=73.8% vs. pandemic 2=76.2%, Chi-squared test p=0.467), nor when stratified by treatment modality or stone size. Rates of operative and pulmonary complications, admission to critical care, 30-day mortality, readmission, and renal function at 6 months did not differ between the data collection periods.

Conclusions: Despite fewer invasive procedures performed during the pandemic, we demonstrated no difference in success of treatment, without an increase in adverse outcomes. This leads us to question whether the management of ureteric stones can be optimised further, as the COVID Stones study has shown that during the pandemic a higher proportion of patients were safely managed conservatively and without hospitalisation.

Source of Funding: None.