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

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]