Renal stone management in the era of the COVID-19 pandemic.

The strain of treating COVID_19 patients is having an impact on the management of urological emergencies. Semi-elective and elective lists are being decimated, and anaesthetist are being rostered to cover intensive care. With a reduction in available theatre space, pressure is mounting on CEPOD lists, thereby delaying treatment.

Surgical Model

Patients presenting with colic should be managed conservatively as much as possible, in order to avoid admission to an overstretched unit. Surgical selection should be carefully performed, prioritising high risk cases so that septic episodes are avoided. Senior clinicians should review the waiting lists and identify low risk cases which can be safely deferred

Decompression of the obstructed/infected kidney can be achieved safely via either stenting or percutaneous nephrostomy. Ureteric stenting seems preferable and where the skill is available, can be performed under local anaesthesia. Nephrostomy is an option in units with the capacity and the facility to do so.

Elective ureteroscopy should be deferred till the risk subsides and in patients with stents, long-term antibiotic prophylaxis may be considered to reduce hospital attendances.

Infections secondary to renal stones are still an emergency and visits to Accident & Emergency may still be required during this crises.

Once the pandemic abates, then specialist urological services will be reinstated.