COVID-19 pandemisi sırasında üriner sistem taş hastalığının yönetimi: tek merkez deneyimi

Year 2020, Volume: 12 Issue: 2, 141 - 149, 23.07.2020

Gökhan Ecer , Mehmet Giray Sönmez , İbrahim Göksoy Mert Arslaner Hakan Taşkapu Arif Aydın , Mehmet Balasar

Abstract

Amaç: Bu çalışmada, NEÜ Meram Tıp Fakültesi Üroloji Departmanında COVID-19 pandemisi süresince üriner sistem taş hastalığının yönetimine ait detayların paylaşılması amaçlanmıştır.

Gereç ve Yöntemler: Çalışmaya Türkiye’de ilk COVID-19 vakasının görüldüğü 10 Mart ile 15 Mayıs 2020 tarihleri arası üriner sistem taş hastalığı nedeniyle cerrahi müdahale yapılan toplam 52 hasta dahil edilmiştir. Hastaların demografik bilgileri, radyolojik ve laboratuvarsal incelemeleri, uygulanan anestezi ve tedaviye göre pre-intra ve postoperatif detaylar, COVID -19 ile ilişkili veriler retrospektif olarak incelenmiştir.

Bulgular: Çalışmaya dahil edilen hastaların ortalama yaşı 49,8 olarak ölçüldü. Bu süreçte en sık yapılan işlem Dj takılması(25 hasta;%48), 2. en sık yapılan işlem ise Dj çıkartılmasıdır (15;%28,8). 13 hastaya(%25) endoskopik üreter taşı tedavisi yapılırken, 8 (%15,3) hastaya nefrostomi katateri yerleştirilmesi, 4 (%7,7) hastaya PNL, 3 (%5,8) hastaya RIRS yapıldı. Endoskopik üreter taşı tedavisi ve RIRS yapılan 16 hastaya aynı zamanda Dj stent takılması da yapıldı. 9 hastada ise taşa herhangi müdahale yapılmadan sadece stent takılması yapıldı.

Sonuç: COVID-19 pandemisi tüm cerrahi branşlarda olduğu gibi ürolojide de hastaya yaklaşım algoritmalarını tamamen değiştirmiştir. Bu süreçte kılavuzların da önerdiği gibi, COVID-19 dışı hasta yükünün azaltılması için elektif endoürolojik vakaların olabildiğince pandemi sonrasına ertelenmesi, acil vakalarda ise obstruksiyonu giderecek müdahalelerin tercih edilmesi görüşü kliniğimizce kabul edilmiştir.

Keywords

COVID-19, endoürolojik taş yönetimi, Üreter taşı, Hidronefroz, Obstruktif Üropati

Management of urinary system stone disease during COVID-19 pandemia: single center experience

Abstract

Objective: In this study, it is aimed to share the details of the management of urinary stone disease during the COVID-19 pandemic at NEU Meram Medical Faculty Urology Department.

Material and Methods The study of the first COVİD-19 cases seen in Turkey between the dates of March 10- May 15, 2020 have been included 52 patients who underwent surgery due to stone disease. Demographic information, radiological and laboratory examinations of the patients, pre-intra and postoperative details according to the anesthesia and treatment applied, and the data associated with COVID -19 were retrospectively analyzed.

Results: The mean age of the patients included in the study was measured at 49,8. In this process, the most common procedure is the insertion of Dj (25 patients; 48%), and the second most common procedure is the removal of the DJ (15; 28.8%).13 patients (25%) were treated with URS, 8 (15.3%) patients were treated with nephrostomy catheter insertion, 4 (7.7%) patients were treated with PNL and 3 (5.8%) patients were treated with RIRS. 16 patients with URS and RIRS were also inserted Dj stents. In 9 patients, only stents were inserted without any intervention to the stone.

Conclusion: The COVID-19 pandemic has completely altered the algorithms for approach to the patient in urology as in all surgical branches. As suggested in the guidelines in this process, In order to reduce the non-covid-19 patient load, our clinic accepted that elective endourological cases should be delayed as much as possible until after the pandemic and that interventions to eliminate obstruction should be preferred in emergency cases.

Keywords

COVID-19, endourological stone management, ureter stone, hydronephrosis, obstructive uropathy

References

• 1. S. Zhao, Q. Lin, J. Ran et al. Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: a data-driven analysis in the early phase of the outbreak, Int. J. Infect. Dis. : IJID : Off. Publ. Int. Soc. Infect. Dis. 92 (2020) 214–217
• 2. World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report – 95. World Health Organization; 2020
• 3. Sağlık Bakanlığı Web sitesi. https://covid19bilgi.saglik.gov.tr/tr/sss/halka-yonelik.html
• 4. Proietti S, Gaboardi F, Giusti G. Endourological Stone Management in the Era of the COVID-19. Eur Urol. 2020 Apr 14. pii: S0302-2838(20)30217-7.
• 5. EAU Guidelines Office Rapid Reaction Group: An organisation-wide collaborative effort to adapt the EAU guidelines recommendations to the COVID-19 era.2020.
• 6. Rosen CL, Brown DF, Sagarin MJ et al. Ultrasonography by emergency physicians in patients with suspected ureteral colic. J Emerg Med 1998;16:865-870.
• 7. EAU Guidelines on urolithiasis. (2019)
• 8. Liu Z, Zhang Y, Wang X et all. Recommendations for Surgery During the Novel Coronavirus (COVID-19) Epidemic. Indian J Surg 2020:1-5.
• 9. Loeffelholz MJ, Tang YW. Laboratory diagnosis of emerging human coronavirus infections - the state of the art. Emerg Microbes Infect 2020, 9(1):747-756.
• 10. Berkow L, Kanowitz A. COVID-19 putting patients at risk of unplanned extubation and airway providers at increased risk of contamination. Anesth Analg 2020.
• 11. Lie SA, Wong SW, Wong LT, Wong TGL, Chong SY. Practical considerations for performing regional anesthesia: lessons learned from the COVID-19 pandemic. Can J Anaesth 2020.
• 12. Gosmanova EO, Baumgarten DA, O’Neill WC. Acute kidney injury in a patient with unilateral ureteral obstruction. Am J Kidney Dis 2009;54: 775–9.
• 13. Ahmad I, Saeed Pansota M, Tariq M, Shahzad Saleem M, Ali Tabassum S. Comparison between Double J (DJ) Ureteral Stenting and Percutaneous Nephrostomy (PCN) in Obstructive Uropathy. Pak J Med Sci. 2013 May;29(3):725-9.
• 14. Novara G, Bartoletti R, Crestani A, De Nunzio C, Durante J, Gregori A. Impact of COVID-19 pandemic on the urologic practice in the emergency departments in Italy. BJU Int. 2020 May 14.