Recommendations from the EAU Urolithiasis Guidelines Panel applicable during the COVID-19 pandemic.
Acute treatment of a patient with renal colic
1) In principle, the same considerations as mentioned in the EAU-Guidelines on Urolithiasis apply, in particular immediate pain relief in patients with an acute stone episode. However, some evidence exists of a link between NSAIDs (Ibuprofen) and both respiratory and cardiovascular adverse effects in several settings, but so far the causality remains unclear. However, the WHO has recommended to avoid the application of ibuprofen when possible. Metamizol seems to be a good alternative in acute renal colic. 2) Renal decompression in case of analgesic refractory colic pain or threatening urosepsis are emergency procedures and shall be performed as soon as the local situation allows.
Medical expulsive therapy (MET) and Chemolysis.
3) In the situation of an infectious pandemic like SARS CoV2 these therapeutic options become more important as a potential way of avoiding surgical interventions.
Choice of decompression must include consideration of the possibilities for outside procedures or at bedside, with use of local anaesthesia thus avoiding the
necessity of admission to the ward and involvement of an anaesthetist, sparing ventilators AND considerations on future therapeutic time lines for definitive
stone treatment during pandemic. Stents might be preferred due to high risk of accidently removing/dislodging a pcN and possible long-wait until definitive
stone treatment can be carried out. In the short-term, preferably use stents with a string for self-removal in order to reduce outpatient visits.
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