Abstract
The study of Julian Cornelius provides a message of clinical utility sustaining the efficiency of immediate extracorporeal shockwave lithotripsy (SWL) in patients with ureteral/pyeloureteral urolithiasis. 1 We would like to emphasize the importance of immediate SWL during the coronavirus disease 2019 (COVID-19) outbreak. It is a fact that in many hospitals, the availability of elective operating theaters has been reduced, because of staff shortage and the reinstatement of nurses and anesthetists to departments reserved for patients with COVID-19 pneumonia. Importantly, according to accumulating pieces of evidence, SWL is a valuable treatment for ureteral stones and can be performed without anesthetic support and the need of recovery, saving the time of operating theaters for other surgery. 2 Furthermore, immediate treatment reduces the risk of multiple admissions to emergency departments because of kidney colic, which is quite common in patients with ureteral stone awaiting elective surgery. Therefore, the immediate SWL permits the treatment of ureteral stones minimizing the contact between patients and health professionals, reducing the risk of a COVID-19 spread. Finally, long-term complications such as ureteral stricture should be considered. Indeed, to delay treatment of ureteral stone favors the stone impaction and this phenomenon is a well-known risk factor for the development of ureteral stricture. 3 Of course, not all hospitals are suffering the same reduction of the surgical activity. The importance of the concepts expressed in this text depends on the disposable resources of every institution and the burden of the COVID-19 pandemic that vary greatly from region to region. In conclusion, in centers provided with lithotripter/SWL facility where the COVID-19 pandemic is causing a reduction of the surgical activity, immediate SWL treatment of ureteral stones should be encouraged.