Optimize the Management of Urological Tube-Related Emergencies During the Coronavirus Disease 2019 (COVID-19) Pandemic

Yang Luan; Yan Zhang; Kai Cui; Fan Li; Baolong Qin; Yajun Ruan; Kun Tang; Hongyang Jiang; Hao Li; Xiaoyi Yuan; Zhuo Liu; Xiaming Liu; Gan Yu; Shengfei Xu; Ruibao Chen; Huan Yang; Xiaolin Guo; Xiaoyong Zeng; Zhong Chen; Zhiqiang Chen; Zhiquan Hu; Xiaodong Song; Zhihua Wang; Shaogang Wang; Jihong Liu; Tao Wang

Disclosures

Transl Androl Urol. 2021;10(1):466-474. 

In This Article

Abstract and Introduction

Abstract

Background: To introduce and determine the value of optimized strategies for the management of urological tube-related emergencies with increased incidence, complexity and operational risk during the global spread of coronavirus disease 2019 (COVID-19).

Methods: All emergent urological patients at Tongji Hospital, Wuhan, during the period of January 23 (the beginning of lockdown in Wuhan) to March 23, 2020, and the corresponding period in 2019 were recruited to form this study's COVID-19 group and control group, respectively. Tongji Hospital has the most concentrated and strongest Chinese medical teams to treat the largest number of severe COVID-19 patients. Patients in the control group were routinely treated, while patients in the COVID-19 group were managed following the optimized principles and strategies. The case incidence for each type of tube-related emergency was recorded. Baseline characteristics and management outcomes (surgery time, secondary complex operation rate, readmission rate, COVID-19 infection rate) were analyzed and compared across the control and COVID-19 periods.

Results: The total emergent urological patients during the COVID-19 period was 42, whereas during the control period, it was 124. The incidence of tube-related emergencies increased from 53% to 88% (P<0.001) during the COVID-19 period. In particular, the incidence of nephrostomy tube-related (31% vs. 15%, P=0.027) and single-J stent-related problems (19% vs. 6%, P=0.009) increased significantly. The mean surgery times across the two periods were comparable. The number of secondary complex operations increased from 12 (18%) to 14 (38%) (P=0.028) during the COVID 19-period. The number of 2-week postoperative readmission decreased from 10 (15%) to 1 (3%) (P=0.049). No participants contracted during the COVID-19 period.

Conclusions: Urological tube-related emergencies have been found to have a higher incidence and require more complicated and dangerous operations during the COVID-19 pandemic. However, the optimized management strategies introduced in this study are efficient, and safe for both urologists and patients.

Introduction

According to the latest data from Johns Hopkins University, more than 43 million individuals in 189 countries, including many medical professionals, have been diagnosed with coronavirus disease 2019 (COVID-19). More than 1.15 million patients had died by October 26, 2020. During the pandemic, medical resources are being fully used to ensure the prevention and control of COVID-19. Urology practices, including specialist clinics, outpatient procedures, and the use of operating theatres, have dramatically decreased.[1,2] It tends to result in ignorance and the delayed treatment of urological problems. Emergent urological problems need to be concerned and treated immediately; otherwise, they will cause serious renal failure or even worse. Common urinary emergencies include urinary retention, renal colic, hydronephrosis and anuria, urological tubes obstruction and dislodgment during the COVID-19 period. Most of these urological emergencies are directly related to or could be effectively solved by urological tubes.

However, routine management strategies may be not suitable at this time given the high exposure risk and operation complexity. Difficult urological tube-related emergent operations may be increasing due to the inconvenience of seeing a doctor and complicated operations caused by treatment circumstances, protective measures, and the possibility of infection with COVID-19 during the pandemic. Therefore, it is important to pay closer attention to the management of tube-related urological emergencies. Common problems include: (I) difficulty inserting urinary catheter caused by severe prostatic hyperplasia, urethral stricture, and urinary tract damage; (II) failure to drainage urine due to bladder clots clogging; (III) difficulty dredging or replacing nephrostomy/cystostomy tube; (IV) difficulty dredging or replacing single-J stent; (V) double-J stent retention-induced sickness. How to prepare a safe and effective plan to improve urological tube-related operations and how to balance COVID-19 prevention measures and emergency treatment during the pandemic merit investigation. To date, Tongji Hospital has the most concentrated and strongest medical teams from the whole country to treat the largest number of severe COVID-19 patients in Wuhan. Here, we investigate the case incidence changes in urological emergencies during the COVID-19 period. In addition, based on clinical practice, we optimize the management principles, strategies, and procedures for urological tube-related emergencies and evaluate their safety as well as effectiveness during the COVID-19 pandemic.

We present the following article in accordance with the TREND reporting checklist (available at http://dx.doi.org/10.21037/tau-20-1194).

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