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Purpose: Patients with chronic ureteric obstruction (CUO) are traditionally managed with polymer stents/nephrostomy. However, these are prone to failure and require regular exchange. This study eva...

ObjectiveThe WHO declared SARS-CoV-2 a pandemic on 11th March 2020 prompting a rapid change to surgical practice. This study focuses on how the management of ureteric colic has adapted in a major tertiary referral unit during the peak of the pandemic so that lessons be can be learned in case a second wave occurs. Materials and MethodsWe compared admission rates and treatment patterns against national and European guidelines in 20 weeks, divided into pre- and peri-pandemic. ResultsA total of 72 patients were admitted during the study period. 64% (46/72) were admitted pre-pandemic. 22% (10/46) of these were septic (5 stented, 5 nephrostomized) while 20% (9/46) were managed conservatively. 59% (27/46) of pre-pandemic admissions were suitable for active treatment, of which 48% (13/27) received definitive treatment (11 ureteroscopy (URS), 2 shockwave lithotripsy (SWL)) all within 48 hours of admis-sion. 52% (14/27) had temporising procedures (11 stented, 3 nephrostomized) and underwent definitive treatment within 63 days.Of the total patients, 36% (26/72) were admitted peri-pandemic. 23% (6/26) were septic (1 stent, 5 nephrostomized), while 31% (8/26) were managed conservatively. 46% (12/26) were suitable for active treatment. 75% (9/12) received definitive treatment (4 URS, 5 SWL) of which 33% (4/12) within 48 hours and the remaining treated and stone free within 12 days. 25% (3/12) had temporising procedures (2 stented, 1 nephrostomized), with the definitive treatment provided within 17 days. ConclusionUreteric colic admissions were reduced by almost half during the pandemic. There has been increased primary treatment with a reduction in temporising procedures and time to receiving definitive treatment. In the ‘new normal,’ lessons learned must be carried forward to maintain high rates of definitive treatments.

OBJECTIVES To evaluate the clinical, fiscal and environmental impact of a specialist-led acute ureteric colic virtual clinic (VC) pathway. PATIENTS AND METHODS All patients with uncomplicated acute ureteric colic, referred to a single tertiary centre, were prospectively entered into the study over a 4-year period (January 2015-December 2018). Inclusion criteria were: low-dose non-contrast computed tomography of kidneys, ureters and bladder; white blood cell count

To evaluate the clinical, fiscal and environmental impact of a specialist-led acute ureteric colic virtual clinic (VC) pathway.All patients with uncomplicated acute ureteric colic, referred to a single tertiary centre, were prospectively entered into the study over a 4-year period (January 2015-December 2018). Inclusion criteria were: low-dose non-contrast computed tomography of kidneys, ureters and bladder; white blood cell count16 × 109/L; pain controlled; normal renal function; and no clinical concern. Primary outcomes were: time (days) from referral to VC outcome; VC outcome (discharge, further VC, face-to-face [FTF] clinic, extracorporeal shockwave lithotripsy [ESWL], ureterorenoscopy [URS], percutaneous nephrolithotomy [PCNL]); and adverse events (sepsis or obstruction). Secondary outcomes were patient and stone demographics, cost and environmental analysis. The minimum follow-up was 3 months.A total of 1008 patients entered the study, of whom 91.5% (n = 922) were of working age. The median (interquartile range) time from presentation to VC outcome was 2 (4) days. VC outcomes were as follows: 16.3% of patients (n = 164) were discharged; 18.2% (n = 183) were discharged after further VC; 17.2% (n = 173) underwent an intervention; and 48.4% (n = 488) were referred to an FTF clinic. Interventions comprised: PCNL 0.5% (n = 5); ESWL 7.7% (n = 78); and URS 8.9% (n = 90). Stone demographics were as follows: 570 patients (56.5%) had lower, 157 (15.6%) had upper, 96 (9.5%) had mid-ureteric and 163 (16.2%) had renal calculi, and in 22 patients (2.2%) the stones had recently passed. The mean (sd) stone size was 3.5 (2.3) mm. Two adverse events (0.2%) were reported. Introducing a VC saved £145,152 for Clinical Commissioning Groups, the equivalent NHS tariff payment of performing 106 URS procedures or 211 ureteric stent insertions. Overall, 15,085 patient journey kilometres were avoided, equal to 0.70-2.93 metric tonnes of carbon dioxide equivalent production and the need to plant 14.7 trees to achieve carbon balance.A specialist-led acute ureteric colic VC reduced time to treatment decision to a median of 2 days. This creates additional clinic capacity and reduces the fiscal burden of traditional clinics and their associated carbon footprint.