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Table 1 Current recommendations and triage systems for treatment of urolithiasis during COVID-19

From: Urolithiasis treatment options during COVID-19 pandemic: review of current recommendations and triage systems

Urgency classification Definition [7, 8, 10] Time to intervene [10, 11, 13] Indications Important considerations
Emergency or Tier 0
[10, 11, 13]
Organ-threatening or life-threatening < 24 h Obstructed infected kidney [11,12,13,14,15,16,17,18, 20]
Obstructing stone in solitary kidney [12,13,14,15, 20]
Obstructing stone associated with acute renal impairment [12,13,14,15, 20]
Bilateral ureteric obstruction [12,13,14,15, 20]
Severe unmanageable symptoms [12, 13, 15, 20]
Offer temporarily drainage if infection and fever present
Consider definitive treatment, except if staged treatment is expected
High priority or Tier 1–3
[10, 11, 13]
It is likely to cause clinical harm < 2–8 weeks Obstructing ureteric stone if failed MET (> 4 weeks), large to pass (> 8 mm) [13] or (> 10 mm) [20]
Symptomatic stone on mediation [11, 13, 14, 16, 20]
Extreme stent-related symptoms [13, 15, 20]
Obstructing ureteral stone [11, 12, 14, 20]
Obstructed staghorn stone [20]
Recurrent UTI on non-obstructing renal stone [13]
Stent exchange [11]
Weigh patient’s risk and surgery benefit before treatment
Procedures with lower auxiliary retreatments are preferred, e.g., URS over SWL
Stentless or stents with strings are encouraged
If possible, insert stents and NPT under local anesthesia to spare a ventilator
If possible, perform procedures as an outpatient or day surgery
To reduce anesthesia time and complications, seniors should do surgery
Low priority or Tier 1–3
[10, 11, 13]
It may cause clinical harm, but it is unlikely <12 weeks Stone with well-tolerated stent or NPT [11,12,13,14, 16]
Bladder stone with recurrent UTI or obstruction [14]
Ureteral stent removal [17]
Postpone or Tier 4
[10, 11, 13]
It is unlikely to cause clinical harm >12 weeks Asymptomatic renal stone [11,12,13,14,15]
Non-obstructing renal stone [11,12,13,14,15]
Non-urgent PCNL procedures [13]
Normal renal function [12]
No solitary kidney [12]
Asymptomatic bladder stone [14]
Ureteral stents and NPT exchange [14, 18]
Ureteral stent removal [16]