Results
We gathered and analyzed all 2-month urological emergent clinic visit data from Tongji Hospital from January 23, 2020 (the beginning of lockdown in Wuhan) to March 23, 2020, and the corresponding period in 2019 (Table 1). The total number of urological emergent patients dropped to 42, barely the one-third of the number in 2019. The incidence of tube-related emergencies reached 88% in 2020, which is significantly higher than that of 53% in 2019 [relative risk (RR) 1.7, 95% CI: 1.4–2.0, P<0.001]. The percentage of non-tube-related emergencies, such as urinary tract injuries and testicular torsion, was dramatically decreased from 47% to 12%.
Apart from the higher mean age seen during the COVID-19 period (69±13 vs. 55±8 years old, P=0.042), the baseline characteristics of patients with tube-related emergencies across the two periods were unchanged. In terms of management outcomes, the mean surgery times (17.7±4.2 vs. 18.4±10.5 min, P=0.950) were comparable. The secondary complex operation rate, which reflects the difficulty of operation and includes all operations except direct tube/stent insertion or bladder irrigation, was higher in the COVID-19 group (38%) than it was in control group (18%) (RR 2.1, 95% CI: 1.1–4.0, P=0.028). This mainly resulted from the increased complexity of replacing nephrostomy/cystostomy/single-J tubes/stents during the COVID-19 period, although none of the specific tube-related emergencies had statistical significance. However, the 2-week postoperative readmission rate was significantly lower in the COVID-19 group (3%) than it was of control group (15%) (RR 0.18, 95% CI: 0.02–1.30, P=0.049). Most of readmissions that occurred in the control group were due to the recurrence of tube obstruction after a simple rinse of blocked tubes. Neither the surgeons nor the enrolled patients were found to be infected by SARS-CoV-2 within two weeks postoperatively.
Of all of the tube-related emergencies, nephrostomy tube-related (31% vs. 15%, RR 2.0, 95% CI: 1.1–3.7, P=0.027) and single-J stent-related (19% vs. 6%, RR 3.4, 95% CI: 1.3–8.7, P=0.009) problems were the most significantly elevated in the COVID-19 group. In the COVID-19 group, the obstruction rates for nephrostomy (46% vs. 11%, P=0.022) and cystostomy tubes (43% vs. 0%, P=0.014) increased, while their dislodgment rates decreased. The incidence and complexity of difficult urinary catheterizations, bladder clots, and sickness caused by double-J stent retention were similar across both groups.
Of the 27 patients who experienced tubes obstruction (urinary catheter, nephrostomy tube, cystostomy tube, or single-J stent), 13 patients (48%) successfully dredged their tubes using sterile saline with video guidance from medical staff and did not need to visit the hospital. The remaining 14 patients (52%) had especially severe or prolonged tube obstruction and were unable to dredge their tubes themselves. These patients ultimately went to emergency department for further management.
Transl Androl Urol. 2021;10(1):466-474. © 2021 AME Publishing Company
