Feasibility and safety of daycare pediatric ureteroscopy in low volume centers: Hints to be considered during Coronavirus disease-2019 pandemic

Several guidelines and algorithms have been established since the declaration of Coronavirus disease 2019 (COVID-19) pandemic to organize work across surgical departments and face the enormous demands on health care facilities without affecting patient's health and safety. Pediatric ureteric calculi is an uncommon condition that may be encountered and requires appropriate triage and management. However, pediatric urologists are not available in all centers, mandating adult urologists to deal with such cases despite the small volume, especially during COVID-19, where patients transfer is restricted. We have reviewed pediatric ureteroscopy outcomes at our tertiary center as adult urologists did all cases. We retrospectively reviewed the files of all pediatric patients who had endoscopic management of symptomatic ureteric calculi between 2013 and 2020. Patient demographics, stone characteristics, operative details, hospital stay, and complications were recorded and analyzed. Twenty-one patients were included, 13 males and eight females. The mean age was 8.4 ± 2.9 years. The mean ureteral stone size was 9.9 ±3.6 mm. 28.6% (n=6) of patients known to have other comorbidities, 33.3 %( n= 7) of patients required pre-operative double J stent (JJ) stent insertion. One lithotripsy session was sufficient for complete stone clearance in most patients, 76.2 %( n=16), while the remaining patients required two sessions. None of the patients developed postoperative urinary tract infection (UTI) or gross hematuria with clots. All patients except one were discharged home on the same day. Daycare pediatric ureteroscopy is a feasible and safe option to be considered by adult urologists in order to treat pediatric ureteric stone disease, especially in the current era of COVID-19 pandemic where the number of beds is limited, and patients transfer is restricted.