Presented by: Ankur Choksi MD
Department of Urology, Yale School of Medicine

Introduction

Patients with an active SARS-CoV-2 infection are at a higher risk of post-operative mortality as well as pulmonary and cardiovascular complications. In this study, we analyze the post-operative safety of patients undergoing cystoscopy with ureteral stent placement for an obstructing ureteral calculi that tested positive for COVID-19.

Materials

We retrospectively identified patients who underwent cystoscopy and ureteral stent placement between June 5, 2020 and December 31, 2022 as an add-on case for an obstructive ureteral stone after presenting to the Emergency Department. Patients were stratified by whether they had a positive COVID-19 test on admission. Baseline characteristics were compared using Students t-test for continuous variables and Pearson chi-square test for categorical variables. Univariate and multivariate logistic regression analysis was performed to identify predictors of postoperative 30-day mortality.

Results

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A total of 1,408 patients underwent add-on cystoscopy with ureteral stent placement for an obstructing calculus, of which 55 (3.9%) patients had a positive COVID-19 test. When stratified by COVID-19 status, both groups were similar with regards to age, sex, race, co-morbidities, indications, procedure duration, and type of anesthesia administered. Patients without COVID-19 had a higher prevalence of chronic lung disease. Of the 137 patients that were admitted to the ICU, 9 patients were COVID-19 positive (16.4% vs. 9.4%, p = 0.09). On multivariate logistic regression, patients with COVID-19 had a higher odds of 30-day mortality (OR 7.06, 95% CI: 2.03 – 24.47, p = 0.002) when controlling for age, co-morbidities, vaccination status, anesthesia type, and indication for ureteral stent placement. 

Conclusion

Patients that underwent cystoscopy and ureteral stent placement for an obstructing ureteral stone with a concurrent COVID-19 diagnosis had an increased risk of 30-day perioperative mortality.

Funding

None

Lead Authors

Ankur Choksi, MD
Department of Urology, Yale School of Medicine

Co-Authors

Soum Lokeshwar, MD, MBA
Department of Urology, Yale School of Medicine

Mursal Gardezi, MD
Department of Urology, Yale School of Medicine

Christopher Hayden, MD
Department of Urology, Yale School of Medicine

Amir Khan, MD
Department of Urology, Yale School of Medicine

Timothy Tran, MD
Department of Urology, Yale School of Medicine

Dinesh Singh, MD
Department of Urology, Yale School of Medicine

Piruz Motamedinia, MD
Department of Urology, Yale School of Medicine

Thomas Martin,
Department of Urology, Yale School of Medicine