Comparison of results and complications of the two techniques of renal stone management: ESWL and mini-PCNL, in the setting of COVID crisis.

It is a retrospective study in which the patients treated with ESWL in the COVID times (from March 2021 to December 2022) were compared to patients that were treated with mini-PCNL after the pandemic was controlled. 50 patients in each group were studied and renal stones up to 1.7 cm in size were considered. Patients aged <18 years, who had a branched stone, advanced hydronephrosis, a solitary kidney, anatomical renal abnormality, or had a surgical intervention within the past 6 months were excluded. Radiological examination included plain abdominal radiograph of KUB and non-contrast CT for the measurement of kidney stones.
Patients were evaluated in terms of post intervention stone free rates (SFR), complications (as per modified Clavien-Dindo classification), retreatment rate (need for a secondary or auxiliary treatment), hospital stay and cost effectiveness. ‘Success’ included patients who became stone-free or had insignificant residual (<4 mm) fragments.

The re-treatment rate and total number of procedures were significantly higher in the ESWL group. There were significant residual fragments in 8 patients after PCNL, and these were treated with ESWL with 100 % success. There were significant residual fragments in 12 patients after ESWL which required secondary procedures in the form of PCNL in 10 and URS in 2.The incidence of complications was significantly higher in the PCNL group. There were complications after ESWL in 3 patients, in the form of steinstrasse that were treated with analgesics and a-blockers in 2, and 1 required ureteroscopy .Complications in the PCNL group included intraoperative bleeding and postoperative hematuria in three, which were managed with clamping of the nephrostomy tube and conservative measures. The mean hospital stay for PCNL was 4.6 days, whereas ESWL was done on OPD basis. The mean total cost was significantly higher for PCNL.ESWL was better tolerated in terms of pain as compared to PCNL.

1. The incidence of complications was significantly higher in Mini-PCNL group     
2. The mean hospital stay for ESWL was less (p <0.001)
3. The mean total cost was significantly higher for Mini-PCNL group.
4. ESWL was better tolerated in terms of pain characteristics as compared to Mini-PCNL.

Despite the great suffering caused by COVID, we had once in a generation opportunity to fundamentally re-examine our health care models. With the declaration of the national emergency and restriction on non-essential medical care, our health care was under great strain. Urinary stone disease accounts for a considerable portion of the clinical workload faced by urologists. ESWL had emerged as a blessing in the pandemic by not only providing effective, uncomplicated clearance of renal stones but also by reducing the exposure to health care workers and decreasing the workload on already overburdened anesthesiologists.

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