ABSTRACT
Introduction It is known that cancer care is best approached by a multidisciplinary team (MDT). This became specifically true in the Covid-19 pandemic in which choices for urological cancer treatment are influenced by many factors. In some cases, delayed treatment may have consequences regarding the patient's oncological outcomes. The aim of the present article is to report our experience throughout the Covid-19 pandemic treating patients with urological neoplasms at a high-volume center. Methods We used a convenience sampling method. Cases were evaluated and discussed on an individual basis at the MDT meetings, and, after a consensus regarding delaying or scheduling treatment, patients were scheduled according to the risk of postponing the procedures. The Medically Necessary, Time-Sensitive (MeNTS) scoring system was measured in each patient; all patients answered the Centers for Disease Control and Prevention (CDC) Covid-19 self-screening questionnaire prior to surgery. The Covid-19-free survival rate was estimated. Results A total of 194 patients were assessed by themultidisciplinary team and finally treated, with median follow-up of 4 (interquartile range [IQR]: 2.75 to 6) months. Only two patients had Covid-19 confirmed by real-time polymerase chain reaction (RT-PCR). In total, 54 patients underwent oncological surgery, 129 were treated with radiotherapy, and 11 were treated with intravenous chemotherapy. Themedian age was 66 years (IQR: 59 to 94 years), and the median MeNTS score in the surgically-treated cohort was 35 points (IQR: 31 to 47 points). Conclusions The evaluation and treatment of urological cancer should be conducted by an MDT; this is of utmost importance, especially during the Covid-19 pandemic. The data collected in our institution showed that most patients could be safely treated by taking all necessary precautions and discussing each case individually in the MDT meetings and performing a close follow-up.
Introduccion La atencioÌn del caÌncer se aborda mejor con un equipo multidisciplinario (EMD), aspecto que se tornoÌ maÌs importante en la pandemia por Covid-19, en que las opciones para tratar el caÌncer uroloÌgico estaÌn influenciadas por muchos factores. En algunos casos, el tratamiento retrasado puede tener consecuencias en los resultados oncoloÌgicos del paciente. El objetivo de este estudio es describir nuestra experiencia en un centro de referencia y de alto volumen para el tratamiento de neoplasias urológicas durante la pandemia por Covid-19. MeÌtodos Realizamos un muestreo por conveniencia. Posteriormente, los casos fueron evaluados y discutidos de forma individual en las reuniones del EMD. Posterior a la obtencioÌn de un consenso sobre el tratamiento del paciente, los pacientes fueron programados seguÌn el riesgo individual de posponer el manejo. Se midioÌ la puntuacioÌn de cada paciente en el sistema Medically Necessary Time-Sensitive (MeNTS, "Médicamente necesario, sensibles al tiempo"). Todos los pacientes respondieron el cuestionario de autoevaluacioÌn del Centers for Disease Control and Prevention (CDC) COVID-19 antes de la cirugiÌa. Se estimó la tasa de supervivencia libre de Covid-19. Resultados Un total de 194 pacientes fueron evaluados por el EMD y finalmente tratados, con una mediana de seguimiento de 4 (rango intercuartil [RIC]: 2,75 a 6) meses. Solo dos teniÌan Covid-19 confirmado por reacción en cadena de la polimerasa en tiempo real (RCP-TR). Un total de 54 pacientes fueron sometidos a cirugiÌa oncoloÌgica, 129 fueron tratados con radioterapia, y 11 fueron tratados con quimioterapia intravenosa. La mediana de edad fue de 66 anÌos (RIC: 59 a 94 años), la puntuacioÌn mediana en el MeNTS de la cohorte tratada quiruÌrgicamente fue de 35 puntos (RIC: 31 a 47 puntos). Conclusiones La evaluacioÌn y el tratamiento del caÌncer uroloÌgico debe ser realizado por un EMD durante la pandemia de Covid-19. Los datos recopilados en nuestra institucioÌn mostraron que la mayoriÌa de los pacientes podriÌan ser tratados de manera segura, discutiendo cada caso individualmente y haciendo un seguimiento cercano.
Subject(s)
Humans , Male , Female , Middle Aged , Therapeutics , Urologic Neoplasms , COVID-19 , Aftercare , Centers for Disease Control and Prevention, U.S. , Drug Therapy , Real-Time Polymerase Chain Reaction , Time-to-TreatmentABSTRACT
Purpose: We analyzed the outcome of medical management for children with vesicoureteral reflux (VUR) and we determined the factors affecting the outcome. Materials and Methods: We retrospectively reviewed the records of 37 patients (56 kidneys) who were diagnosed with VUR between 1995 and 2004. All the patients were maintained on prophylactic antibiotics and had regular follow up. The subjects were stratified according to the grade of reflux at the time of diagnosis into the low grade group (grade III or below) or the high grade group (grade IV or above), based upon the International Classification System. The effects of the reflux grade, the presence or absence of renal scar, the age at diagnosis, laterality of disease and gender on the improvement/resolution rate of VUR were analyzed. Results: The mean duration until resolution was 35 months. Improvement occurred in 48 kidneys, including resolution in 27 kidneys. The resolution rate was higher in the kidneys with low grade reflux than that in the kidneys with high grade reflux. The resolution rate was higher in kidneys without scar than that in the kidneys with scar. A significantly higher improvement rate was observed for the children diagnosed before 1 year of age than that for the children diagnosed after 1 year of age. Conclusions: The most significant factor determining the outcome of medical management for children with VUR is the reflux grade at diagnosis. Medical management is appropriate in the management of low grade VUR. It may also be a viable treatment option for high grade VUR in selected cases.